Lining and labs/ hemolyzed specimens

  1. 5 So it was decided by our hospital that it is no longer "acceptable" to draw labs when starting an IV--i.e. they have to be peripherally stuck for blood in addition to the stick for the IV start. The supposed reasoning behind this is that too many blood specimens were hemolyzed when drawn during an IV start, especially compared with the hemolysis rate for phlebotomists drawing on the floor.

    So, we were 'provided' with a phlebotomist and it apparently showed or hemolysis rate went down when they drew blood. What I find interesting is that they were doing such a great job that, yet they went from working in the ER from 11a-11p to now just working 11a-7p. In addition, we are the first place from which a phlebotomist is pulled if they are short staffed (so that they cover the whole house). A coworker also make an interesting observation. When the phlebotomist draws blood they send it to the lab in a colored biohazard bag, while the biohazard bag that we have in stock is clear plastic with the biohazard logo on it. The coworker suggested that if the specimen shows up in the colored bag, the lab treats it differently so that it does not come back hemolyzed or the ignore minor hemolysis on these specimens, yet they always report even the smallest amount of hemolysis drawn on samples drawn by ER staff. Not sure if I buy into the conspiracy theory, but it is an interesting thought.

    I have been told by several ER docs and residents that this is a foolish policy and that they line/lab (all in one stick) "everywhere." One doc, who happens to run the residency program for the hospital system asked me "who came up with such an inane policy?"

    Anyway, just looking for comments from other ER nurses. Anyone else have to deal with something so silly?
  2. Visit  psu_213 profile page

    About psu_213, BSN, RN

    psu_213 has '6' year(s) of experience and specializes in 'Emergency, Telemetry, Transplant'. Joined Mar '11; Posts: 3,195; Likes: 6,994.

    70 Comments so far...

  3. Visit  Career Changes profile page
    1
    Nope. We draw labs when we line, and unless flow is very slow, or extremely fast, there are no issues.
    icuRNmaggie likes this.
  4. Visit  whichone'spink profile page
    1
    Quote from psu_213
    So it was decided by our hospital that it is no longer "acceptable" to draw labs when starting an IV--i.e. they have to be peripherally stuck for blood in addition to the stick for the IV start. The supposed reasoning behind this is that too many blood specimens were hemolyzed when drawn during an IV start, especially compared with the hemolysis rate for phlebotomists drawing on the floor.So, we were 'provided' with a phlebotomist and it apparently showed or hemolysis rate went down when they drew blood. What I find interesting is that they were doing such a great job that, yet they went from working in the ER from 11a-11p to now just working 11a-7p. In addition, we are the first place from which a phlebotomist is pulled if they are short staffed (so that they cover the whole house). A coworker also make an interesting observation. When the phlebotomist draws blood they send it to the lab in a colored biohazard bag, while the biohazard bag that we have in stock is clear plastic with the biohazard logo on it. The coworker suggested that if the specimen shows up in the colored bag, the lab treats it differently so that it does not come back hemolyzed or the ignore minor hemolysis on these specimens, yet they always report even the smallest amount of hemolysis drawn on samples drawn by ER staff. Not sure if I buy into the conspiracy theory, but it is an interesting thought.I have been told by several ER docs and residents that this is a foolish policy and that they line/lab (all in one stick) "everywhere." One doc, who happens to run the residency program for the hospital system asked me "who came up with such an inane policy?"Anyway, just looking for comments from other ER nurses. Anyone else have to deal with something so silly?
    Nope, I draw when I can with the IV. I had a question though? Does anyone screw the blood transfer device directly onto the catheter and fill up tubes that way, or do you draw with a syringe? I have wondered if hemolysis would be decreased by cutting out the extra step with the syringe
    icuRNmaggie likes this.
  5. Visit  KBICU profile page
    1
    I never use the syringe i hook up the male connector and draw blood right from there
    icuRNmaggie likes this.
  6. Visit  beingcaitlin profile page
    2
    I'm a phlebotomist and in my experience I often see nurses pulling back too forcefully on the syringe when obtaining blood from an IV stick, especially if its a small gauge anywhere other than the AC. As for the lab screwing with ur specimens... Why would they do that it just makes more work for them, not to mention the smallest amount of hemolysis will falsely elevate the K. I think it is a no brainer to get blood from an IV stick but if its not an easy stick or the blood return was sluggish you might as well have the phleb come because u will get the results faster than waiting for the lab to reject the spec and then have them come up and stick them anyway.
    icuRNmaggie and cynthiagrier like this.
  7. Visit  eatmysoxRN profile page
    3
    I was a patient at a place that apparently had this policy and I had a nurse starting an IV in one arm and less than 5 minutes later a phlebo on my other arm. I asked why they didn't grab some blood and save me a stick (I'm a difficult stick...) and they said it was against policy. I ended up feeling like a pin cushion since my iv was placed in my only decent vein.

    When I float to ER to start ivs or have to restart on the floor close to when labs are due I'll always draw blood. The ER starts always get a rainbow and on my unit I call the phlebo and get them to bring me the tubes they need since we don't stock them.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
  8. Visit  Career Changes profile page
    2
    We don't have phlebotomists in our ER. I've never used a syringe to pull blood specimens either. We put the blood collection device directly on the hub of the IV set (Nexiva or Jelco) and draw from there. Rarely is there an issue with return, but manipulation of the catheter (withdrawing slightly or advancing) usually allows for bloodflow unless it's a bad line.
  9. Visit  ChristineN profile page
    3
    I have never heard of this and can't imagine the pts are thrilled. In my ER we not only draw labs when we put lines in, but we also will continue to draw off the IV as long as they are in the ER. Since we have been boarding a lot lately, some of these pts end up being down here for a day or so. By that point, I hate drawing off of a smaller IV as it seems to hemolyze more readily
  10. Visit  psu_213 profile page
    1
    Quote from beingcaitlin
    Why would they do that it just makes more work for them, not to mention the smallest amount of hemolysis will falsely elevate the K.
    I generally don't think they are...this is just another nurse's thought on why we get so many hemolyzed BMPs/CMPs. I guess it is based on 'competitiveness' between departments as every department is time in everything they do (for example, nurses are timed for how long it takes to from an order for CBC, BMP, etc. to that particular specimen to be received by the lab....lab is timed for how long it takes for a specimen to be received until we get a result).
    icuRNmaggie likes this.
  11. Visit  psu_213 profile page
    1
    Quote from ChristineN
    I have never heard of this and can't imagine the pts are thrilled
    They tell us that pt's have not complained about this. I presume this means our PG scores have not suffered. Then again, they may be trying to get us to drink their Kool-aid.
    icuRNmaggie likes this.
  12. Visit  sunflower918 profile page
    2
    I have been a phleb for 20 yrs...(grad from lpn school 3 yrs ago). Have to say that I agree with beingcaitlin; can't really think of a reason why any reputable lab would 'ignore' even slight lysing of cells in a spec as it can cause inaccurate results to be reported. This could result in potential harm to a patient (via treatment plans changing based on labs, etc). The last thing lab staff want to do is have that happen, or be reported to any of our regulatory commisions for such an incident. (Talk about the PG scores going bad...lol).

    Maybe a more reasonable approach from the OP's mgmt may be to specify policy that prohibits line labs under certain patient conditions i.e., he's suspected or known to already have existing problems with K, serious anemias, etc. Don't know how "real world" that might work but just a thought.

    Sorry for lack of paragraphs-new to posting here and trying to navigate the ins and outs
    icuRNmaggie and NRSKarenRN like this.
  13. Visit  hiddencatRN profile page
    5
    I find the lab is often out of touch with the realities of patient care. In the peds hospital I worked at, the lab was insistent that we use vacutainers to draw blood from while starting an IV. The problem is, in a fragile, little vein that you were lucky to sink a 24 in to, the vacutainer often blows the line from the pressure. The labs are important, but so is having that line and access so the general practice is to ignore the lab and do syringe draws on smaller patients to protect the IV site while getting the labs. And guess what, most of those specimens are just fine. And a vacutainer is by no means a guarantee that the labs won't get hemolyzed on draw anyway.

    I've also worked places where the labs insist on very large amounts of blood in order to do various tests. Fine when you're dealing with an adult, but in a teeny patient, that blood does add up when these are labs that get repeated over the course of hospitalization (plus, little veins, dehydrated kids, etc often simply do not give you the volume of blood the lab desires). I've had labs insist you need 10cc of blood in a culture tube to culture. Seriously? No, you don't.

    And don't get me started on calling the lab to find out why the results are taking WAY longer than usual to have the lab say "oh, the specimens only *just arrived.* BS. I walked that bag over and dropped it in the window personally because we needed the labs ASAP

    Anyway. I've worked in multiple hospitals and the lab always seems completely inflexible to the reality that sometimes we just have to do the best with what we are able to get on patients. I would not be surprised if those red bags are "stat" bags and the phlebotomist's samples get run first.
    JustaGypsy, nuangel1, canoehead, and 2 others like this.
  14. Visit  ♪♫ in my ♥ profile page
    2
    That policy is absurd.

    I've always drawn blood from lines, if at all possible. In my former position, I ~always~ drew into a syringe - and I still do if it's a slow draw. I can think of about 5 times out 1,000 draws or more that have been hemolyzed.
    JustaGypsy and icuRNmaggie like this.


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