Blood draws

[Jenni811, RN]

The hospital i work at now has phlebotomy that comes up and does blood draws on our patients (using needles), so we as nurses don't do them.

the hospital i did clinicals at had the nurses do blood draws, which is fine and all, but they drew blood from the peripheral IV. This was something i never really heard of, so i asked about it. They said yea you are at risk for collapsing the vein, but if you do it slowly it is rare that it happens. They shut the IV fluids that are running of for about a minute before drawing blood, and do a "waste" tube. They acknowledged not being able to do blood cultures with a peripheral.

I guess when you think about it though, what really is the difference??

Does anyone have any information on this? It still seems a little odd to me that they do this, but at the same time it makes sense. so what do you think about drawing blood from a peripheral IV? (With the exception of blood cultures)

[sunnycalifRN]

Nothing wrong with drawing labs from a peripheral IV. It requires a little critical thinking, however. If a patient is on a heparin drip, I would never draw the blood for the PTT from that heplock . . . best practice is to do a new peripheral stick on the opposite arm. Same concerns for drug levels.

Large gauge peripherals, 16 or 18, work much better, for drawing blood, than the tiny gauges, also.

[nrsang97, BSN, RN]

I only draw off peripherial IV's if they are just put in otherwise I don't. I think we have a policy stating not to do this. Most of our patients have arterial lines or central lines or picc lines, but we get peripheral blood cultures on everyone.

Also I only draw off them if they are 20 gauge or larger. Smaller can cause the blood to hemolyze.

[JSlovex2]

maybe i mis-read, but isn't it bc of the risk of infection/bacteria?

[SunDazed, BSN, RN]

Drawing blood off an established PIV (vs one that is freshly accessed) esp. if it is small gauge... you run the risk of losing your IV access. Then starting a new IV can be more painful for the patient than a phleb stick for blood, as well as more time consuming for the skilled person starting the IV.

With a fresh IV access I have taken blood for labs on 22 and larger... but there is definitely more risk of hemolyzing the sample with 22g v. 20g or 18g.

[LegzRN]

Remember to waste the first lab you draw off of a PIV.

[Jenni811, RN]

I just don't see why our hospital does not implement this, so thats why i was wondering if there is evidence saying that you shouldn't do it from a peripheral.

It just seems so....nice for the patients.

Heck, if they had a fresh IV placed or one in a good vein such as an AC, why not???

So is there anything that says you shouldnt??

[merlee]

As a patient, I was thrilled when the nurses drew blood from my PIV. Hurray!

[SunDazed, BSN, RN]

Here is one hospitals EBP policy on why they chose not to..

http://www.allina.com/ahs/united.nsf/page/EBP.PlabDraws3.09.pdf/$FILE/EBP.PlabDraws3.09.pdf

[3rdcareerRN]

With a fresh IV access I have taken blood for labs on 22 and larger... but there is definitely more risk of hemolyzing the sample with 22g v. 20g or 18g.

A phlebotomist can successfully use a 23- or even 25-gauge needle. I myself often use a 23-gauge butterfly and have never had lab reject my specimens due to hemolysis.

If there is evidence-based guidelines about hemolysis when using small-gauge needles, can you point me to it please? I'm not being snarky, I want to improve my practice.

[NewNavyRN]

My hospital has a specific policy on drawing blood and it does not allow for using PIVs. Actually it says never to use them for risk of contaminating a sample. I'm sure other hospitals are different.

[DogWmn]

When I took my phlebotomist course last year we were taught NEVER to draw from a PIV, reasons given were contamination and duluted samples creating incorrect results.

I would check with your Lab policies and procedures to verify.