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)
"Nothing wrong with drawing labs from a peripheral IV."
Well, This statement is not accurate, all of the time. If one needs to draw blood from a peripheral IV catheter, it should ONLY be done upon insertion.
Infusion Nurses Society discourages the use of a peripheral IV for blood draws as one not only decreases the life of that line, but the smooth endothethial cells are damaged when you perform this practice.
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.
I suspect there are differences between a 22 g NEEDLE and a 22 g soft, collapsable CATHETER
in school we were taught that it was ok to draw when the line is first inserted, but not after it has been used at all. i have been to hospitals who allow it, and those that don't due to Infusion Nurses Society discouraging it. it all depends on your facilities policy. as a student(and i suspect as a future rn as well), i don't feel comfortable drawing from a piv and risking losing access. if they don't have a port-a-cath to draw from, i stick 'em.
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.
I have used 23 and 25 gauge butterfly needles for phlebotomy too... I think that you would have to find out the tech specs on the butterflies vs. the angiocaths... the measurement of gauge may not be the same between different types of products... the angiocath has the plastic catheter that is inserted with the guide needle, and the buttefly doesn't.
Maybe you can contact a tech rep from the supplier to find out how they measure up against each other? Don't forget to let us know what you find out!:)
Specializes in Infectious Disease, Neuro, Research.
Former Senior Phleb- there are several differences. When performing venipuncture, the difference between a quality specimen from a 22-20 vs =/>25g is rate of aspiration. If aspiration is too fast, the specimen is lysed, too slow and it coagulates/increases presence of clotting factors. This applies to any gauge, but, obviously, incidence is much higher with smaller gauges.
Angiocaths present several issues. First, AC sites were mentioned. Try this- take a drinking straw, and bend it at a 90* angle. Feel those sharp little points at the bend? That's what angios do when bent. Those angles abrade the vessel walls. No big issue, in any single event, but we need to consider the lifespan of the pt. Long term, and after multiple punctures in the same location, with 3-5 day dwell time, this is very traumatic to the vessel.
Equally, if the angio has a bend, that is decreasing the ID, which, in turn, increases lysis. Secondly, there is dwell. Depending on what is being administered, residue within the angio may alter serum chemistry. Actually it will, the question is what amount of variance is acceptable when using a reasonable waste-draw.
Phlebotomy/venipuncture is thought of as a lower tier skill consideration. But. Each time you perform a venipuncture, you are performing microsurgery, with all the attendant implications.:)
IVRUS, BSN, RN
1,049 Posts
"Nothing wrong with drawing labs from a peripheral IV."
Well, This statement is not accurate, all of the time. If one needs to draw blood from a peripheral IV catheter, it should ONLY be done upon insertion.
Infusion Nurses Society discourages the use of a peripheral IV for blood draws as one not only decreases the life of that line, but the smooth endothethial cells are damaged when you perform this practice.