Who Draws blood from a-lines??

[bran1101]

i have a question for all intensive care nurses. we are having a debate at the hospital i work at about who can draw blood from an arterial line. in our cardiac intensive care unit, they have in the past allowed the patient care techs to draw blood from a-lines. in the other adult icu's we feel that this is definately wrong and not even covered in the scope of practice of a pct. we have written to our state board of nursing to ask but are awaiting a reply. so i just wanted to get everyone else's opinion on this matter.

thanks!!

[Ahhphoey]

In the ICU where I work, only the RN and RT can do anything with the a-lines. In the hospital where I supervise, though (another hospital system), the nurse care partners can draw off of a-lines and they have not had any major issues with this procedure.

[BurgdorfRN]

In my unit a CVICU unit RRT and RN are the only ones allowed to touch or access Arterial lines and that is how it should be. As a RN you are ultimately the only one responsible for the patency qnd integrity of the line. So if you feel comfortable then let the tech do it but each institution has its set of policies as to the scope of practice and I'm sure access to art line is not in a tech's scope.

[JSTARZ]

RN's ONLY!

[RescueNinja]

RRT's that are certified to insert can do so, but RNs are the only ones allowed to do draws. Then again, we don't have any support staff - all RNs.

[ChadlyRN]

I'm a new graduate nurse working in an ICU where I used to work as a PCT. We NEVER were allowed to draw any blood from an a-line. The only blood samples we took were by a lancet for an accu check for a blood sugar. I don't doubt a tech could handle drawing from a line, but it worries me something could go wrong. :mnnnrsngrk:

[MedicineCNS]

GAHHH! RNs only that sounds like and ID nightmare :)

[CNL2B]

In my facility in patient care areas RNs and RTs routinely draw blood from art lines. In the OR though, their PMTs (patient monitoring technicians) actually INSERT the lines, draw blood, assist with swan placement (do all the setup, etc.) and do a lot of other really skilled procedures. It's not rocket science, and it's not like they are administering a medication (which requires licensure.) Another facility I worked in, phlebotomists were actually allowed to draw blood off PICCs and triple-lumen central lines, which I consider to be a much higher-risk type access (as far as blood stream infections goes.)

I would not worry one bit if we had appropriately inserviced technicians drawing blood from art lines. If you turn the stopcock the wrong way, you know it right away, and if for some reason someone did walk away from the bedside with a line open, the monitor would go off (and nobody makes that mistake twice ... LOL). I would be thrilled if someone else drew my q2-4-6h labs while I did something that actually required an RN license.

[HazelLPN, LPN]

I work in a NICU and RN's only handle A-lines. As a new grad it even took me a couple times to feel comfortable with them, I don't think I would want someone else drawing off my lines...

Unless that person is an experienced LPN who remembers the days when we didn't even have A lines.

We had something called a leach if you wanted to get blood out of your patients. It was so annoying with them squirming too and fro....have to wrestle them off the artery. Ugh.

In all seriousness, I remember the first A-lines lines in the 1960s. At first nurses didn't draw anything off of them....the docs did that. We started doing our own draws probably late 60s/early 70s.

Here both RNs and LPNs draw off the A-lines. LPNs have a full scope of practice with few restrictions. Most of them have 20+ years of experience....all know their stuff very well.

We have a position called a Nursing Assistant II who is a student nurse enrolled in nursing school who has completed so many of her/his clinicals in school. She/he may draw off the line under the immediate supervision of an RN. The same is true for our nursing technicians...they have finishined nursing school but have yet to take or pass their state boards. Its a good way for these kids to get hands on critical care experience under the direction of an experienced nurse....kind of like how we learned in the old diploma schools EXCEPT they get paid and we were slave labor.

Best to you,

Mrs H.

[wanderlust99]

I've never seen a PCT draw blood from an art line. It doesn't seem appropriate IMO. I've worked at one hospital where RTs were allowed to draw a blood gas from an arterial line, but that's it. All other hospitals (I'm a traveler) it's been RN only. Even some nurses draw the blood incorrectly from an arterial line. Until a MD showed me the correct way to draw from one I was doing it wrong for years. Pulling too fast from the vamp and flushing continuously into the line.

[Nurse J in OH]

In our unit RNs and RRts draw off A-lines. I know that PCTs in the unit might have more training than other places (maybe), but it is still my patient and therefore my responsibility. I would rather not leave that to someone with minimal training.

[ScittyRRT]

In our hospital, both RNs and RTs can draw from A-Lines, both after having been signed off that they are competent to do so (which involves numerous supervised draws, including demonstration of the ability to troubleshoot).

I agree with what others have said about scope of practice . . . I would think in most states this would be outside their scope. Again, I also would reiterate that this has nothing to do with anyone's ability to draw from an A-Line, but with established scopes of practice . . . which presumably determines what is safe for the patient and what happens if something does go wrong in terms of liability!!

[pawashrn]

Depends on the training and who takes responsibility if the aline blows. I have never let a tech draw from my alines and I observe RT's the first couple of times to be sure they treat it with care. Because that is my life line in caring for this patient and if someone else blows it, I am the one who has to call the physician and assist in putting in a new one. While trying to titrate drips off a cuff that won't register. Truthfully, other than cleaning/turning and getting food for my patient my PCT does nothing else for my pt. Control maybe. But if the mistake is made I want to own the responsibility. I love MY RT's. I don't think they get the correct they deserve.