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| No. 20 | 
Jul 02, 2005, 10:02 PM
I work as a phlebotomist for a clinical laboratory while in nursing school. I stick about forty LTC facility residents per day, five days a week. Many geriatric patients must be stuck in the hand. They arms are often stiff due to arthritis, etc, so they are unable to extend the arm. I ONLY carry 23g butterflies for the hand stick. I might have one hemolyzed specimen per week, max. If it's an easy stick, you should never have a hemolyzed specimen using a 23. The red cells "break" when the stick is next to impossible. But a hemolyzed specimen only affects chemistry tests, such as K, Mg, Lytes, etc. Med level results like Digoxin, for example, are not affected by a hemolyzed specimen.
Another potential problem with hard sticks is clotting in the tube. It doesn't matter in a serum separater tube (SST), but I'm notorious for clotting purple tops (EDTA). Grrrrrrr......
 | | Advertisement Sponsored Links | | | | No. 21 |
Jul 17, 2005, 11:53 AM
 depends why?
We start the cap, take the blood, then start the IV.
If it requires blood cultures, we do the same thing, but the second set of cultures gets drawn 20 minutes later, prefferebly from the opposite arm.
| | No. 22 |
Jul 17, 2005, 12:23 PM
There have been numerous articles written and published in nursing and laboratory journals on the reasons blood shouldn't be drawn when starting IV's. Hemolysis is likely even when using larger gauges, it has to do with the angiocath collapsing when suction is applied. In our facility a lengthy study was done, and with the amount of specimens that were having to be redrawn, it was actually taking more time than just letting the phlebotomist or nurse draw with a needle the first time.
| | No. 23 |
Jul 17, 2005, 10:00 PM
When I worked as a phlebotomist doing nursing home collections, almost all we would use were the 23g butterflies, and we rarely had hemolyzed specimens... I would use a small syringe and try to carefully control the pull on the vein.
Is it difficult to keep the catheter in place while drawing the blood? I haven't done via an IV catheter, but to me it seems like it would be easy to pull it out of the vein.
abmsam I know exactly what you mean about the lav tubes clotting - it frustrated the heck outta me!!!  | | No. 24 |
Jun 19, 2009, 12:13 PM
Re: IV starts and drawing blood Originally Posted by Dixielee  This procedure is routine where ever I have worked. It saves the patient sticks and saves you time. My procedure is to cannulate the vein as usual, then connect an unflushed 7 in. extension line to it. Tape the needle down, but do not completely dress it as sometimes you may need to manipulate it a bit. I then connect my vacutainer or syringe (vacutainer makes it less likely to get blood spills and you never come into contact with a needle), and connect my tubes. Our blood culture bottles fit into the vacutainer as well, but you need to prep the skin for cultures if you plan on them. Once my tubes are filled, I flush the tubing with saline, cap with saline lock and then hook up my fluids. That way, if you need to change tubing etc. later, you do not have to manipulate the catheter. I found it you do not use the extension tubing when you draw, you risk losing your line as you change syringes or tubes, especially if it is a small gauge catheter. If the patient moves or jumps, you are already in a relatively secured line with tape.
Your explanation is so wonderful! I just have one question: how do you connect the vacutainer to the tubing?
I need to draw blood on HIV patients and then provide them w/ immuno IV therapy, so I'm concerned about my safety and about their comfort. Thank you!
| | No. 26 |
Jul 25, 2009, 01:10 AM
Re: IV starts and drawing blood
I work on an adult med/surg floor and while the nurses do start IVs fairly regularly in general we don't get blood from the IV unless the person is a hard stick. While we like to avoid any extra sticks we don't want to have to redraw a patient if the sample from the IV was bad or risk ruining the IV site because of a blood draw. On the rare occasion we will use an IV insertion to get blood from the nurse will hook up a syringe to the short extension tube that connects to the catheter and draw into the syringe and then they will flush and cap until the site is needed.
!Chris  | | No. 27 |
Jul 25, 2009, 05:59 PM
Re: IV starts and drawing blood
we draw from ivs on insertion all the time no problem in our ed .we use 18-20 mostly some 22 .we also have butterflies .cultures require 2 sticks.we do have a few redraws but mostly no problems.
| | No. 28 |
Jul 27, 2009, 03:20 PM
Re: IV starts and drawing blood
In my DEM its pretty standard practice to go ahead and start an iv on the majority of pts (unless they are there for chronic back pain x 10 yrs and they decided to just now come in for it lol), after threading the catheter into the vein and the needle's taken out we apply pressure where the cath tip would be and connect a vacutainer directly to the hub of the iv, draw a rainbow, then apply pressure again, remove the vacutainer and connect the saline lock, flush and then pop a tegaderm on and tape it down. a lot of us have found that drawing the blood from the tubing after connecting the saline lock results in our potassiums coming back hemolyzed more than 50% of the time.
| | No. 29 |
Aug 06, 2009, 12:08 AM
Re: IV starts and drawing blood
To the nurse that says 18G. . .nah. You can infuse blood through a 20. On an adult, it is more ideal to have an 18G, but it isn't always possible. If you can influse blood through a 20, you can certainly obtain labs.
Overall it's a finese kind of thing--drawing carefully to prevent hemolysis and inserting the IV and drawing blood without making too much of a mess.
In kids--shoot on newborns, you get a lot of labs by way of heal stick. Talk about finese. On some kids it's a pain in the butt--and for those, I'd rather have a nice vein or artery to draw from.
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