Blood draw from IVs?

[alkaleidi]

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

[jenfromjersey]

My ER recently did their own study after reviewing the hemolysis rates of specimens we draw and feeling that it was too high. We, like many other ERs, draw blood back from the angiocaths immediately after starting them and before they are flushed.

For one week during the trial, a phlebotomist from the lab was assigned to the ER and she drew blood straight stick (no butterfly needles) from every patient that came in. If they needed an IV then they got stuck twice. (Codes and traumas were a different story obviously)

We all thought that the hemolysis rate would be so much better and we got excited at the prospect of possibly having a dedicated phlebotomist in the ED.

Unfortunately the results of the trial were surprising as the phlebotomist draws had a hemolysis rate that was so slightly better than ours that it was not even statistically significant. Interesting. So what we determined was that it has a lot more to do with technique...for example, tourniquet time left on the patient has something to do with it I believe as well as obviously the size of the vein you are drawing from...an inner wrist vein drawn through a #22 ga may end up hemolyzed. Most times, I know immediately by how the blood looks going into the tube if it's going to be hemolyzed. Honestly, if I have any doubt at the time...I save the IV line and redraw from a straight stick..if it is a veinless person..I do an arterial stick with a butterfly.

[COLPN]

In my experience working in a lab as a phlebotomist it was very rare for us to have to go stick the patient again due to hemolyzed specimens. When they were hemolyzed I found it was usually a smaller bore IV, 20g or less,, and the nurse or EMT who started the IV said they could barely get it to flow and so they spent a lot of time "fiddling" with it to get the blood to flow. The great majority of samples were accepted by the lab to be run.

[TraumaNurseRN]

In our Level II Pediaric/Adult Trauma Center (RNs) can draw from the angio site but medics,techs or LPNs are not allowed to do so. There has been a few occassions where hemolyzed blood has been an issue but I find it's when you have a small angio, or a bad vein anyway. Angio size (such as when we do pediatric blood draws with an IV start have been successful for the most part)...but they too have issues periodically.

[Roy Fokker, BSN, RN]

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."

If I were in your shoes, I'd ask said manager for a copy of that "documentation".

Not to be confrontational - but to 'educate self'. After all, your manager wants you to follow appropriate policy, yeah?

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

Ditto here.

About the only thing I like to do is replace the extension tubing the medics put in with our own kit - our medics here use a flimsy tubing set and blood drawn off of that set almost always ends up hemolyzed.

Other wise, I draw labs with my IV stick and always draw a "waste" if I'm drawing labs again subsequently. Unless I'm doing blood cultures, I see no reason to stick the patient again if I have a patent vascular access device which gives me good blood return.

cheers,

[RedSox33RN]

I will draw labs from the initial IV start, as long as it's a 20 or larger and in a good vein. If it doesn't draw well but flushes, I'll do or let the lab do a butterfly stick elsewhere, rather than risk the line. This is especially true for the elderly and dehydrated pts.

I'll also do BC x1 off of a new IV start. If it's more than 15 min old or an EMS start, I won't, because it's culturing the blood AND the line. (And must say here, that a few nurses I worked with at my last ED were so concerned about just getting the blood and checking off their running timers, that they were draw BC x2 from the same existing line at the same time - really chaps my behind, because it does no good for the pt).

I do find it interesting all the different policies. The different hospitals I've worked at always state one policy, but will also say things are "different" for the ED.

[Pat_Pat RN]

We've had this same story at my hospital. Lab did some testing, and found it was particular nurses that had the problem, not "technique" (ie drawing through a PRN adaptor, through pigtail, into a syringe-then to the vacutainer...etc...)

I've recently started using a 12cc syringe with a PRN adaptor on it, screwed straight to the end of the cath, draw back 12cc (depending on what is ordered) through the adaptor into the syringe. Then let the vacutainers pull the blood out of the syringe, not push it in.

Unscrew the syringe and the PRN adaptor is already on, no mess!

(I was kinda known for my bloody messes when starting IV's....)

[Nccity2002, MSN, RN]

Hi ,

I can feel your frustation...Find (google) the articles provided below, they may be able to support your point with your manager.

1) Laboratory sampling: Does the process affect the Outcome?. by Kathleen Becan-mcbride. Journal of Intraveneous Nursing. May/June 1999. Volume 22-Issue 3. page 137

2) Blood Samples Drwan from IV Catheters Have Less Hemolysis When 5-ml( vs 10 ml) Collection Tubes are Used. By S. Cox and J. Dayes. Journal of Emergency Nursing. Volume 30-Issue 6, pages 529-530

Good Luck.

[Guest219794]

On a side note-

Many places seem to have a policy of allowing a draw on an initial stick, but not once the line has been used. What's the logic? Or better yet, what's the evidence behind disallowing a practice which is widespread in critical care? In the ICU we regularly draw from central lines that have been used with various drugs and fluids. The only difference I see is that those lines are in bigger veins, but that seems irelevant. In fact, the tubing is longer, and has been exposed to far more substances than the average ER line. It's a question of the proper amount of waste, which is either 1.5 or 2.5 times the priming volume.

[wibobr]

Look at the ENA websight, there have been numerous articles over the past couple of years on the subject. From experience I will tell you it is a learning curve but one that is easily mastered with practice.

In our facility, we are allowed to draw blood from IV's, we also have CNAs trained in phlebotomy. I, as a standard of good practice and in the interest of patient comfort and satisfaction, ALWAYS draw blood from an IV start. (I hate to pay for the sale of the same real estate twice!) If the patient is febrile, I will also draw at least one blood culture. In most cases, thee blood is immediately sent to the lab to be spun down. Such practice definately increases TOT for lab results, increases patient satisfaction (one stick instead of many) and our docs love the forward, critical thinking!

[tommytrauma59]

I also have never been able to find the written support of this practice and also have rarely had a hemolyzed sample due to using a 10ml syringe and drawing slowly, even from a 22g IV cath.

[rbyrdrn]

Wow I am disappointed to see this policy go into place. When placing an IV in the ED, I routinely draw a rainbow for lab, and of course depending on s/s, cultures, lactic acid..., I noticed that p we began using these new vacutainers, which attached to the IV cath, there was an amazing relationship to 22g IV cath and hemolyzed blood. I started using a syringe for blood draws c my 22g and fixed that problem. I agree c Larry77, a little education goes far. And sometimes I think it is the lab!

[LilgirlRN, ADN, RN]

Don't worry the patients will start complaining and all will go back to normal.

I rarely have hemolyisis. Most of the time I use a ten cc syringe instead of vacuutainer. I've also been known to pop the top off tubes and let blood trickle in when I have to use a 22 or 24.