IV starts and drawing blood

BTW, you would be surprised at how some local yocal community ED's won't streamline the process and insert IV and draw labs. This is one reason--among many--why I prefer working in a lot of city or university hospitals as opposed to some community hospitals. One local yocal ED would only let their IV team insert IVs--meanwhile the kid was so dehydrated, I thought she was going to exanguinate right then and there. It would be very frustrating for me to work in such a "mother may I" environment.

Nuangle,I totally agree.

I work in a Pediatric ER where I start 5-10 babies/toddlers every shift, and our docs always want blood drawn with starts. The way we found to not hemolyze or affect our samples, and keep in mind we usually only draw cbc/bmp/crp/cultures, is to start an IV, no matter what size, put pressure on the vein, and place the tube directly under the catheter hub, allowing the sample to drip carefully into the tube. Then we get the culture by using a sterile syringe for that small amount of blood. A benefit is the vein bleeds at its own rate, and I find they stay patent much more often than when using vacutainers or syringing out all the blood. It coud make it messy if you don't have everything ready, but I've gotten used to it this way. ANd lab has never had a problem with this.

I almost always start my cath, pull the needle and connect a 7"? (we call it a pig tail) with an empty 12mL syringe via a PRN adaptor. I then draw blood via the syringe, slowly. Filling the 12mL syringe gives us plenty of blood for a green, purple and blue top tube. If it is someone who I think will need blood cultures, maybe T&S or a lactic acid, I just take the first syringe off and put on another one. Then I attach a flush syringe and flush it. Tape the works down and you are good to go. You have only made 1 possibly dirty connection, the pigtail to the cannula.
That is why I like this method, not nearly the possibility of infection from sticking the vacutainer collector in the cannula hub, taking it out and reconnecting the IV tubing.
We have vacutainer guards with a luer lock connector to screw to the syringes.

I think lots of the hemolysis occurs from the speed of the "suck" from the vacutainers. When you can feel cavitations....it is going too fast!

Our lactic acid lab draw protocol dictates that we draw that tube first, and without a tourniquet. Let me tell you, that is sometimes a VERY difficult draw!