probably a dumb question about PIVs and drawing blood... - page 2

by rach_nc_03 14,343 Views | 22 Comments

hey- i'm a new grad, working in a picu...i had some issues for my first 2 months with an impatient and rather harsh preceptor who was more likely to say, 'why aren't you understanding this??' than to actually help me learn...so,... Read More


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    I would draw from a peripheral IV if the blood flowed easily. Unfortunately I find that after the line has been in for a few hours I am less likely to be able to get a non hemolyzed sample unless it's a big line in a huge vein, so usually it's easier on the patient and the lab to just use a fresh site. Need to also consider that every time you mess with that site you could lose the IV, so I won't even try to draw if the patient doesn't have great veins.
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    Quote from hrtprncss
    hello i'm not a Peds or a PICU RN so I guess this might sound dumb to those that are....But with a running IVF, it's allowed to draw blood samples from the same site as where the peripheral IVF is running? I always thought that there's higher chance of hemolysis among other things that's why we're told not to draw blood from existing peripheral IV's...I mean I do work with alot of 18 or 16 g PIV's with IVF's, r u telling me I've wasted my time sometimes having to stand there with a butterfly looking for the last vein of a hard stick patient when I could have just as easily drawn it from the PIV? I mean yes during insertion I can draw prelim labs but after that I've always thought it was vein sticks...I'm just wondering

    Having worked in both Peds ED and Adult Med Surg, I found the adult floor did not allow us to draw labs from an PIV because they said it caused the IV to go bad sooner. In Peds Emergency where I work now, we draw the labs from the PIV if we can get them to draw even if we are infusing fluids. The reasoning is that it is such a huge, dramatic deal for the child to be stuck in the first place, we will not do additional sticks if we can help it! Of course if the IV won't draw, we have to butterfly stick, but we avoid it at all costs of we can help it!!
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    Quote from hrtprncss
    Interesting, something new to learn from everyday I suppose, since I work in an environment where patient's almost always have CVC or an Aline, I guess all the years I've worked in the ICU setting, I've never seen one ICU nurse draw blood from a PIV with a mintenance IV going, nor from a hep lock...Personally I would frown if I see someone do this, but mainly because probably of lack of knowledge from the standard of practice that's used in different places in the hospital. Now my question is, for the other ER nurses out there....Is this done in your ER? And for the floor nurses and ICU nurses....Are these done in your unit? What's the thinking behind doing this as oppose to having nurses stick patients then if the patient has a hep lock with a large gauge for drawing labs...Keeping in mind that there is backflow from that heplock....I'm sorry did I just learn to be a good phlebotomist out of a myth? ALL responses would be appreciated.
    I AM A 9 YEAR LPN THAT IS ABOUT TO GRADUATE FROM A RN PROGRAM. I WORK ON A PED FLOOR HERE AND I CAN TELL YOU THAT MY BOSS WOULD RAIN HELLFIRE ONTO MY HEAD IF I TRIED TO DRAW A LAB FROM AN EXISTING PIV. IT WOULD NOT MATTER TO HER IF IT WAS BEING USED OR NOT. OUR POLICY IS THAT ONCE FLUIDS ARE ATTACHED TO THE CATHALON THAT IS IT FOR GETTING BLOOD OUT. WE DO TRY TO GET PRELIM LABS WHEN THE IV IS FIRST STARTED BUT AFTER THAT WE HAVE TO STICK OR LAB DOES. SOME OF THESE KIDS ARE HARD STICKS BUT GETTING BLOOD IS EASIER THAN STARTING AN IV SO IF YOU MESS UP YOUR IV THEN WHAT HAVE YOU GAINED EXCEPT CAUSING THE CHILD TO HAVE ANOTHER STICK OR MORE THAN ONE. I FOR ONE WOULDN'T DO IT AND WOULDN'T WANT IT DONE TO MY CHILD.
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    Were I work we really are not suppose to draw from an existing PIV. However, there are times we do. If we have a child that is a hard stick or a child that is totally tramatized by getting stuck, we usually will try. I have heard that the PIV is more likely to go bad if used for labs. We have not had any issues with false lab values by using a PIV.

    However, you did mention giving blood back (waste) which we are not allowed to do ay my hospital. Of course the waste from a PIV is practically nil anyway. But, our CIVs are 5cc's for each draw. That can certainly add up. On occassion we have had a doc write an order where we can give waste back if we use a closed system, but it is certainly nothing we do routinely.
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    I guess peds is very different from adult med/surg. Where I work it is against our policy to draw from an existing PIV, unless we get the labs at the same time we start the IV (and then it isn't an existing PIV, it's a new one). Another thing the OP said that we never do - drawing off waste first and then re-infusing it after we draw the labs. Is that customary in peds? We would never do that...
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    On the pedi floor I work it is not a policy but it is something we do not do. We try to get the labs during the initial IV start, if unable a lab tech will do it. Once an PIV is in & working we do everything to protect it. Sometimes there is too much of a risk of losing the IV with the blood draw.

    Nobody likes to stick a kid multiple times. We try our best to make the experience not so traumatizing by using cold spray, LMX or a Synera patch prior to any lab draws or IV starts.
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    This is an interesting thread.

    We don't typically draw from PIV's unless we have just started it, because most of our patients are infants who are hard sticks and have small gauge IV's. We have occasionally drawn from a PIV if it is large and seems to have good blood return. On our floor we get labs at least once a day, and the risk of losing a 22 or 24g IV is too high.

    It's also policy where I work not to return waste unless there is a specific order to do so, and there rarely is.
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    I guess my thought is why stick a kid if you can get a non-hemolyzed sample from a PIV? On my peds floor we routinely draw daily labs from existing PIVs, even babies with 24s or kids with fluids running. If you flush well and get a good enough waste your results come back the same as a fresh stick. Of course, I have had hemolyzed samples from an IV but I have also had hemolyzed samples from a fresh stick. We don't have lab techs or phlebotomists to do our sticks. We the nurses do them all. If the kid has IVF fluids running, I just turn them off (at the tme of the draw, not 5 or 10 minutes), flush, waste, and draw. If I have dextrose in my fluids, my glucose level still comes back normal. If I have K+ in my fluids, my K+ doesn't necessarily come back high. In fact, many times I have been able to go into a baby's room at 3 in the morning, get my labs from the IV, and never wake up the baby or even the parent. I don't like sticking kids any more than I have to. Of course, if the lab comes back funky, I will stick them for it.

    As far as returning the waste, the only place I have seen that is in NICU. We don't do that on our floor.
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    Research supports that it's best practice not to draw blood from a PIV unless the IV has just been started and hasn't been flushed yet. Whether all hospital policies support this or whether nurses even follow those policies is another question. Of course it seems easier to prevent another stick, especially in children, but this is not the way it's supposed to be done. Basic nursing fundamentals say the specimen is invalid if taken from a used IV line even after waiting for a few minutes. Its unfortunate that your preceptor made you feel like a moron because she was in the wrong herself!
    wooh likes this.
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    I know I am not a peds patient but I was recently in the hospital, in the ICU they put a big honkin 18g in my hand (I work peds cicu/nicu so 18 g seems HUGE to me!) to draw labs (I already had a 20 in my AC and they were trying to be nice by not having a piv in each arm) they said they would put those in their pts w/o a-lines for labs, however on the floor they were not allowed to even put in PIVS never mind draw labs off them...kind of strange in my opinion, especially for an adult hospital.


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