Blood draw from IVs?

Specialties Emergency

Published

Of all the people who currently DO draw blood from IVs...

Can anyone send me info supporting this practice? Our ED is going to be going from that back to starting IV with 1 (or more) stick, and drawing blood with a separate stick. I have worked in the ED both here and in another far larger hospital for approx 1.5 yrs and have *NEVER* had a specimen from lab have to be redrawn due to it being hemolyzed. Maybe just my luck, but they are saying that hemolyzed specimen are why we are going back to separate sticks... and the only evidence-based practice findings that they can find support the idea that drawing blood from IVs causes hemolysis and inaccurate labs. I agree it happens on occasion but I think it happens from butterfly/needle stick blood draws as well... just can't find documentation to support.

Thanks in advance!!!

-A

Specializes in ER.

Since being a new grad RN, I always draw labs with the initial IV start and have never had a specimen hemolyze at my new facility. Where I used to work as a tech, I did all the blood draws using a butterfly (if the pt. didn't need an IV start or for repeat labs) and had many incidences of hemolysis.

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Specializes in Emergency, Nursing Management, Auditing.

I don't know what the policy is for blood draws from IV's at the hospital where I just started working... but at my old hospital we always drew bloods off the initial IV stick. We started having problems with hemolysis when we switched over to tubing that corresponded with our new Plum Pumps and the loops were different... thicker plastic or something of that nature. Even if you had a great 18g or bigger half the labs hemolyzed. Prior to that, I had stuck tons of patients and never had one specimen hemolyze. So I think it might depend on the system you use.

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Specializes in Open heart and heart transplant and E.D.

If anyone that has responded this concern does find any evidence based journal, kindly forward me the link. Thanks

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Specializes in Med/Surg ICU.

I read a study a couple of years back. I don't remember the study size or anything like that. All that I remember is that they said using an 18g and drawing through extension tubing helped reduce problems. On another note dont tell the lab that you're drawing through 24g.

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I hate to be a butthead, but please allow me to refocus the discussion to what I intended it to be:

Please, if anyone has scholarly research or any supporting documentation from a professional organization, I would appreciate (somehow) being given that. I know that many, if not most, hospitals/etc draw blood from IVs, and I personally love to do so, but personal debate is not what I started this thread is for.

I haven't seen the documentation that the ED manager has -- I'm actually a "travel nurse" (living about 2.2miles from the hospital, LOL) soon to be a PRN staff nurse... all I've been told is "We have found documentation saying that there is too much hemolysis causing abnormal and inaccurate lab values with blood draws from IVs, so now we are changing policy to drawing blood from separate stick."

I think it's stupid and it's probably because a lot of the nurses in the ED who have been there quite awhile are 20-22G IV starters, and I am more apt to put a 16 in if the patient has a huge garden hose of a vein, even if they don't really "NEED" the 16... if nothing else it's great access and not likely to blow or infiltrate! I know all of our personal arguments for/against as I've searched for this info on here and found a lot of personal opinion, but...

I am seeking anyone who has actual research/"official" documentation... something that our manager will look at and say, "Oh, ok... let me review that and maybe we will reconsider." I can't exactly print a 50-page thread from allnurses.com's most loyal members discussing their love of drawing blood off IV starts, and give it to her as evidence. ;)

Again, thanks in advance if anyone can help with this.

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I work at a few different facilities and one of them has a policy "banning" blood draws from IV starts unless it is a code or trauma situation. I think it's silly and still draw the blood and have had no c/o hemolysis at all.

I hope none of your bosses are reading this. Are there any other rules that you find silly and choose to ignore?

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Specializes in Emergency/Trauma/Education.

Here you go...I found this through CINAHL. I agree with a previous post. It's about technique. You can hemolyze blood through an 18ga if you suck the plunger back hard enough!

Baer DM; Baer DM MLO: Medical Laboratory Observer, 2008 May; 40 (5): 34 (journal article - questions and answers) ISSN: 0580-7247 CINAHL AN: 2009962756

To summarize:

  • Specimens collected by non-laboratory personnel have a bigger hemolysis rate than those collected by the lab.


  • In one study. 12.4% of specimens drawn by the ED were hemolyzed versus 1.6% drawn by the laboratory.(1)



  • Another study evaluated over 500 hemolyzed samples for the cause of the hemolysis. It found that 78% of the cases were related to blood being drawn too vigorously into a syringe through a needle, IV catheter, or from an infusion line. In 5% of the cases, blood was forcibly squirted from a syringe into a tube. (2)


  • Another study, carried out by emergency-room nurses, compared hemolysis in specimens obtained tbrough a catheter (hemolysis rate = 13.7%) with venipuncture specimens hemolysis rate, (3.8%). The hemolysis rate was inversely proportional to tbe diameter of the catheter, with the highest hemolysis rates in 24-gauge to 20-gauge catheters. (4)



  • A problem involved in collecting blood through a catheter or IV infusion tubing is that the diameters of the catheter, tube adaptor device, and cap-piercing needle may be mismatched, causing changes in pressure on the RBCs during collection, with rupture of some of the cells.


ED staff should be educated about the problem and its solutions. The

third reference contains a good summary of the causes of hemolysis, with a discussion of practical steps to prevent it.

    References

    (1) Burns ER, Yoshikawa N, Hemolvsis in serum samples drawn bv emergency department personnel versus laboratory phlebotomists. Laboratory Medicine. 2002:33:378-380.

    (2) Carraro P, ServJdm G, Plehani M. Hemolyzed specimens: a reason for rejection or a clinical challenge? Clin Chem, 2000:46:306-307.

    (3) Stankovic A, Smith S. Elevated serum potassium values: the role ot preanalytic variables. Am J Clin Pathol. 2004;121:S112-S105,

    (4) Kennedy C.Agenmuller S, KmgR. et al. A comparison of bemolysis rates using intravenous catfieters versus venipuncture tubes for obtaining blood samples. J Emerg Nurs. 1996:22:566-569.

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    Specializes in Infusion Nursing, Home Health Infusion.

    Well I can tell you what the standard of care is from the IV therapy community and the National standards. It is an acceptable practice to draw blood right after an IV stick. In other words once it is being used for medications and fluids leave it alone (does not routinely work well either). WHY stick the patient if you do not have too. I really agree with the above post a little education is needed here. I spend a lot of time in our ER and on occasion I can not easily draw from my start and I usually can tell ahead of time it is going to be a no go on the blood......so I just do a separate stick. The nurses just need to be told to draw slowly....if you have a lot of vibration slow down more so the cells do not break....if you are struggling to get a full syringe and it is not happening use what you have before it clots.....smaller syringes may be needed and tend not to collapse the vein walls together. When it fails do another venipuncture. Investigate where the issue started.so you can address it . It might be lab complaining. Hey I have an idea...Call them to draw it after you start the IV...kinda mean...huh...only if they started the problem

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    Specializes in Emergency Nursing.
    If anyone that has responded this concern does find any evidence based journal, kindly forward me the link. Thanks

    I have just completed a study on this topic that is currently submitted for publication, and I can tell you there are a ton of published studies out there in academic literature.

    It would probably suit your needs to do your own search of the literature to find exactly what you are looking for that suits the situation. You can include and exclude any variable you want to make your search more narrowed down to your interest. Doing your own research and compiling a review of literature would give you credibility. Try CINLAHL, MEDLINE, or OVID and you will find plenty of research.

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    Specializes in Trauma/ED.
    I hope none of your bosses are reading this. Are there any other rules that you find silly and choose to ignore?

    I don't hide it...I label as a nurse draw...if they had a problem with my technique they can let me know. To me it is about the patient first, why make them get a second stick just because some nurses don't know how to draw blood effectively.

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    We draw from the IV with the initial IV start and after it's been in.

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    Our facility allows us to draw labs when we initiate IV access. I usually just draw with a 12 or 20cc syringe screwed into the angiocath. When I am done I attach a hub and secure the site. If there is a re-draw or an add on hrs later that the lab cannot use the blood I have previously drawn, the lab tech comes and does a straight stick. In other words, if the IVL has been flushed we are not allowed to draw from it!

    This is ok of course on the patient's that have been given the TNKase after an MI where not IV sticks are allowed. Seems like if it works then fine, why not spare everyone else the extra pokes!

    Renee

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