Nurses can't draw blood, its always hemolyzed

We draw our own labs in dialysis and what I found was they werent rotating the tubes gently after the draws and just setting them down also or shaking them too severely. The tubes would sit for a few while they did something else and would be hemolyzed. Therefore if any preservative or anticoagulant they werent mixed well causing hemolyzed specimens. Except our tiger tops they always sit for 30min then we spin. Everything else straight in the fridge never sitting down. Just a thought.

I understand your irritation...for some reason other floors believe that ICU nurses are great at starting IV's (which makes you wonder, since almost everyone in ICU has a central line or PICC). There is nothing more irritating to me that to be called to assist with a "hard stick"...you get there and notice that the patient doesn't have any punture sites...

Do you work at my facility? All samples are hemolyzed....20+ nurses daily drawing incorrectly? Don't think so....

We all use 20 g and above iv caths when drawn....I don't even use the tourniquet unless necessary. HOWEVER it really shouldn't matter....babies 24 g needles, ports and piccs-drawn.....and butterfly 25 g....so.....is it the new system between BD and Baxter(2 years old)? God forbid we should buy it from the same company

Is it the tube vac system shaking them up?

Is it the lab leaving them laying around for 1-2 hours....ooooh that might be it! At least if you work in my facility....

Anyway...the ER doesn't do anything special to hemolyze samples....in my own investigation it comes down to receiving or in our case accessioning....now I call and tell them all of mine are stat....guess what? Rarely a hemolyzed sample...

Hmmmmm........

I don't know about all of you, but I want my iv and blood done at the same time...One stick...and so do the patients!

Maisy

PS drawing through the line is a big no no with me...but our phlebotomists have been known to do it!

Personally as a nurse I will only say that I hate drawing blood. It is the one thing in nursing that I absolutely hate doing. If I had wanted to draw blood I would have gone to school to be a lab tech. Unfortunately since I went to school this task has increasingly fallen on nurses. Anytime I look for a new job I am careful to find out if the job includes drawing blood. Even starting IV's doesn't bother me. It is just something about fussing around with the little tubes while hold still and keeping the patient still- yuck! The worst stress.
Still, no one has ever said my blood was hemolyzed that I recall. Though in home care it is either a venipuncture or a central line that we draw through. Useless butterflies always seem to clot off before the blood is done.

Leaving a tube laying around will not cause hemolysis. I worked for 5+ years in a lab before becoming an RN. It was common practice to draw an extra clot tube. These extra tubes would sit in a rack by my computer and would get used if additional tests were ordered during the day. I have spun down tubes that are 8+ hours old and they were fine.

I agree that the high rate of hemolysis seen in ERs is due to collecting samples from peripheral IV sites. In the last few years our techs have started doing most of the IVs and collecting blood samples, which I am totally against. In addition to probably not being adequately trained I feel like that is asking them to do too much. Not to mention that most patients would probably prefer and feel safer with a nurse performing the procedure.

Whenever the ER would call us back saying that they could not get anymore blood on the patient and several nurses had tried, I would usually be the one that had to go down there. Whenever I walked into the room and saw no dressings on the patients arm I would ask the patient how many times they had been stuck and usally they would reply that they hadn't been stuck after their IV had been started. If the patient had a huge vein...and I am talking about one that I could see as I was walking through the doorway, I would usually go find the nurse and tell them where they could stick him at to get a blood sample. Of course I would only do this when they weren't getting slammed. If they refused I would pull them aside and tell them that if they did not go and at least try to stick the patient that I would write them up for unprofessional conduct.

I've never had an ER patient with a hemolyzed specimen, and they send most of their samples off of the IV starts, even a 22-gauge. They place angiocaths, which have a stiffer catheter & less likely to collapse as you're drawing blood out. I work on the floor, where we use insytes, which are more likely to hemolyze if you pull back forcefully on the plunger. You have to have great blood return & basically move the plunger out of the way as the blood is freely flowing into the syringe. I won't bother trying to draw blood off of an IV start that isn't really bloody.

ICU nurses are good from all their practice running around the hospital doing everyone else's sticks Floor nurses half the time would rather run 12 things on one 14 gauge IV then try and start a new IV. At least I would.

We had the same problem at our facility, and there are a few things that have helped tremendously. Out night lab girls are awesome, so we have a good working relationship. If I have the lab standing beside me and waiting for the tubes, they can tell just by how the blood is flowing if there's going to be a problem. We almost always try to draw blood then we insert an IV. I think it's a good policy, because if you can get everything in one stick, it's worth the try.

We've stopped using syringes. When in a hurry, it's easy to pull back to hard when the blood's flowing easily. We started using vacutube adapters, made specifically to attach to the end of an angiocath, and it's made a big difference. After the initial 'I'm not used to it this way', it's really easier. The adapter is easier to hold, so there's less accidental loss of the IV site w/ movement during the draw.
We also now recognize as nurses, that if we have a difficult stick, we need to draw two chem tubes, just in case. We can also tell that if it's flowing two slow, we need two chems. All my kids get two chems just because- if possible. We tell the pts upfront that we're going to try to get blood when we start the IV, but that sometimes the lab may need more.
We also make sure we draw the blood in the proper order. Proper order not only helps w/ chems, it makes sure the coags are accurate as well.
After these changes, we almost never have hemolyzed blood anymore.