Drawing Labs from IV Line

[abundantjoy07]

Q: What's the easiest way to explain to a patient that you cannot draw blood from their IV line? Usually these lines don't give back blood and trying is futile. I generally explain that a smaller gage IV is placed and pulling back on the line causes the vein to collapse from the pressure, thus no blood return. But this is like talking in tongues. Any easier explanations?

[OttawaRPN]

Well, I have a simple reply: "It's against our policy." Ha.

In the ED, they will draw off a start only. We do not do that on the floor (I'm not sure why, honestly, but it is what it is).

Someone on this thread (sorry, can't remember who) asked why we can sample off central lines and not PIV's. Well, the end of those caths are in a much larger vessel than a PIV. It's apples and oranges.

What difference does the end of the cath make? Venous blood is venous blood. Whether you take it from the PICC or poke the patient and take it that way. For the record, many PP have stated their facility does allow them to use existing PIV for blood draws.

[cherrybreeze, ADN, RN]

What difference does the end of the cath make? Venous blood is venous blood. Whether you take it from the PICC or poke the patient and take it that way. For the record, many PP have stated their facility does allow them to use existing PIV for blood draws.

I never said they didn't. I say that is MY response, because my facility doesn't allow it.

I'm not going to go in to explaining the difference, as it is obvious....beyond the "they're both venous blood." Of course they are.

[caroladybelle, BSN, RN]

We try to draw off a new start if possible; onc. pts. don't have many veins to work with so we try to save them sticks whenever possible. We did the same thing when I worked in the ED.

Same here.

It is not optimal practice, and there are various studies indicated that coags are altered by doing that. However, if you have Q4 or Q6 draws on a new dehydrated leukemic, you do what you have to do.

[OttawaRPN]

I'm not going to go in to explaining the difference, as it is obvious....beyond the "they're both venous blood." Of course they are.

Well, if it's only obvious to you then maybe you should have kept it to yourself.

[CCL RN, RN]

Non-nurses should not be accessing central lines!

I dont know if the techs know how to properely access, waste, flush, dwell (w/hep unless contraindicated), clamp (or don't clamp), assess, etc,etc...

It takes me 2 mins to draw labs from a PICC, so relying on a non licensed person to do this does not save me time and only endangers our pts...

[IVRUS, BSN, RN]

What difference does the end of the cath make? Venous blood is venous blood. Whether you take it from the PICC or poke the patient and take it that way. For the record, many PP have stated their facility does allow them to use existing PIV for blood draws.

Where the catheter tip terminates makes a HUGE difference! Standards put forth by INS (Infusion Nurses Society) state that drawing labs from a short term peripheral IV catheter, i.e. a catheter less than 3 inches in length, should NOT be done. You do not have the blood flow in your short term peripheral IV catheters that you have in your central vascular. Therefore, damage to the smooth tunica intima of the vein is more pronounced/prevelant when drawing out of a catheters which terminates in the arm. Once damage to the smooth tunica intima occurs, you set the stage for phlebitis and thrombus.

All policies should state that drawing from this short term peripheral is not acceptable. Knowing standards of care, and following policies and procedures are important to keep you out of a litigious situation.

[CCL RN, RN]

. For the record, many PP have stated their facility does allow them to use existing PIV for blood draws.

That makes no difference. The question asked was not, "how many people have policies on this?";

instead, the question was, "what is best practice?"

And those two questions are totally different. We should all be striving to achieve best practice for our pts...hopefully those hospitals are using EBP to back up their policies.

[OttawaRPN]

That makes no difference. The question asked was not, "how many people have policies on this?";

instead, the question was, "what is best practice?"

And those two questions are totally different. We should all be striving to achieve best practice for our pts...hopefully those hospitals are using EBP to back up their policies.

I'm well aware of the question, as I'm the one who asked it. Clearly different policies are in place as has been evidenced by the varying responses in this thread. So where is the link that proves drawing from a PIV is not best practice?

[steelydanfan]

I'm well aware of the question, as I'm the one who asked it. Clearly different policies are in place as has been evidenced by the varying responses in this thread. So where is the link that proves drawing from a PIV is not best practice?

I agree, but EVERY hospital I have worked in has a policy that states labs may NOT be drawn from peripheral IV's .

Apparently, there have been problems with technique, so a blanket policy has been issued. Since there are more detailed poliicies for central lines, apparently there is some leeway here. But as far as I know, NO line draws are ever allowed for clotting studies as the risk for heparin contamination is simply too great. I would love to hear about your hospital's policies if they differ.

[GHGoonette, BSN, RN]

I decided to follow this up today, so I spoke to an RN who works for a pathology firm. According to her, no blood samples are ever drawn from IV lines as the results will not be accurate.

A line draws are ok, however, as long as the person obtaining the draw is sufficiently skilled to do so without contaminating the line or damaging the artery.