Lining and labs/ hemolyzed specimens

Specialties Emergency

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psu_213, BSN, RN

3,878 Posts

Specializes in Emergency, Telemetry, Transplant.
If a patient is in ER and may be having an MI, correctly drawn blood samples are very, very important. Foolish concern over an additional needle stick lab draw can needlessly prolong treatment time.

If the pt is having a STEMI, he/she will (should) be in the cath lab long before any chemistry results are back from the lab.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.

I think there's a common misconception that high hemolysis rates off of PIV draws are due to the use of the IV for drawing, when actually the research shows stronger connection to technique when drawing off PIV's than it does to the PIV itself. We can see this in studies where we compare hemolysis rates when drawing off of IV's using different techniques and pre-education/post-comparison studies. The exception is with 22 gauge and smaller IV's where hemolysis is often due to the IV rather than technique.

The general rule is that facilities should monitor their hemolysis rates and intervene, typically with education, if their rates are above the standard range, if that fails then they should switch to hard-needle draws only.

At my facility we routinely draw initial labs with the IV start, our hemolysis rate for those draws is 4% which good for even hard-needle draws. We also place IV's solely for drawing blood in some patients, but it has to be a 20g or larger in the AC.

Guests

Guest

0 Posts

It's pretty rare that I place 22g in adults but on occasion I do and generally, I'm able to pull labs off of them for the next few hours.

This debate starts to sound like the dogmatic declarations that contrast studies can only be successfully executed through a 20g or larger placed in the AC... which is simply not an absolute truth.

Just last week I had an elderly patient on whom the best line I could secure without ultrasound was a 22ga in the forearm. It coughed up serial crits and admit labs as well as permitting successful CTcon studies of the abdomen, pelvis, and chest.

psu_213, BSN, RN

3,878 Posts

Specializes in Emergency, Telemetry, Transplant.
This debate starts to sound like the dogmatic declarations that contrast studies can only be successfully executed through a 20g or larger placed in the AC... which is simply not an absolute truth.

Don't even get me started on how different CT techs will accept different IV gauges/placements for CTAs.

Editorial Team / Moderator

Lunah, MSN, RN

14 Articles; 13,766 Posts

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I have drawn acceptable/non-hemolyzed specimens from adults using 22g or even 24g IV catheters in the thumb/knuckle/inner wrist/wherever I can get it. I just draw very gently using a 3cc syringe. I rarely have any specimens hemolyze (until now, when the IV Gods will no doubt slap me for my hubris with a week-long hemolysis-fest, haha).

e102587

8 Posts

ENA, the Emergency Nurses Association in Des Plaines Illinois, revised a TIP's sheet publishing in late 2013 that is aimed at reducing hemolysis in peripherally drawn blood samples. In the Supporting Rationale section the first listing reads "Multiple studies have shown that significantly higher hemolysis occurs when blood is drawn through an IV catheter." There are ten (10) research articles referenced as supporting this statement.

e102587

8 Posts

No labs will be forthcoming if the sample is grossly hemolyzed. Regardless if the patient is sent to cath lab or not.

Guest219794

2,453 Posts

I understand how going through a huber, or using a syringe to draw can hemolyze blood. But, how can any iv catheter be more inclined to hemolyze blood if a vaccutainer is used? What is the difference between that and a lab draw?

Also-

When possible, 18 in the AC, no tourniquet for the draw. since startnig that, no bad specimens.

Ozzy84

397 Posts

Specializes in GI Surgery Step-down.
I have drawn acceptable/non-hemolyzed specimens from adults using 22g or even 24g IV catheters in the thumb/knuckle/inner wrist/wherever I can get it. I just draw very gently using a 3cc syringe. I rarely have any specimens hemolyze (until now, when the IV Gods will no doubt slap me for my hubris with a week-long hemolysis-fest, haha).

How safe is to draw blood on running IV cath?? I know some people does and than all results come high/low and not accure , due dilated w iv fluid.

Is this really right practice to draw a blood from iv cath ? (Not central or PICC)

Editorial Team / Moderator

Lunah, MSN, RN

14 Articles; 13,766 Posts

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
How safe is to draw blood on running IV cath?? I know some people does and than all results come high/low and not accure , due dilated w iv fluid.

Is this really right practice to draw a blood from iv cath ? (Not central or PICC)

Check your facility policy, but it can be done if you discontinue the fluids for a bit.

Altra, BSN, RN

6,255 Posts

Specializes in Emergency & Trauma/Adult ICU.
How safe is to draw blood on running IV cath?? I know some people does and than all results come high/low and not accure , due dilated w iv fluid.

Is this really right practice to draw a blood from iv cath ? (Not central or PICC)

Note that this thread is in the Emergency Nursing section. In the ER, the majority of patients have IVs (saline locks) inserted ... doesn't mean that there is anything infusing. Also ... in most instances blood specimens are drawn immediately after inserting the line - nothing has been infused yet.

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