Blood specimen from iv sites.

Nurses General Nursing

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Okay so yesterday ,a lady from the lab approached me to draw lab from a peripheral iv site that has been used for days,told her I can't that if it's a newly inserted iv I would,informed my charge nurse and house supervisor and they equally said no.So today ,my unit director asked me why I didn't get blood for lab and I told her the same thing I told d lab lady and she said No,it doesn't matter.So my question is,is it really a good practice to draw samples from an iv that has been in situ for days?

Specializes in Adult and pediatric emergency and critical care.

We have been drawing off of existing IVs in the ED and Peds for a long time, why it has taken the rest of the adult world so long to catch up is beyond me. There are certain tests that cannot be drawn off of existing IVs (tacro levels, cultures, et cetera), but beyond that there isn't a reason to keep poking the patient for routine testing when the IV draws.

I would love to see some literature that shows that drawing a sample off of an IV either increases infection risk or failure rate of IVs. Most of the adult IVs we replace upstairs are clotted from the nurses being afraid to aggressively flush IVs rather than from infiltration and certainly not from draws (since our inpatient adults RNs refuse to draw off of IVs).

Specializes in Med-Tele; ED; ICU.
I can NEVER find old posts on Allnurses...but there was a fairly recent one about what's the longest time a patient has kept the same IV site. Shockingly the evidenced based answers were that the "old" change every three days policy seems to be unnecessary. They can stay in as long as they work and appear okay.

Hopefully you are better at finding old posts than I am. It was very interesting.

I started that post...

and I routinely draw blood out of lines that are days old...

The line to which I was referring in that post was >40 days and was still being used for daily lab draws.

The only lab which demands a fresh stick is a blood culture set.

Specializes in Med/Surge, Psych, LTC, Home Health.

Interesting thread... my facility just recently laid down the law, that

labs are NOT to be drawn from PIV's, only from PICC lines or Central lines,

or ports. I'm honestly not 100% sure of the reasoning.

What labs were you drawing?? Blood is blood. The lab results wouldn't be different.

I'm trying to understand people's rationale on this. Why does it matter if the IV is "days old"? If you are concerned that it is possibly infected, why is it still even in?

If you take care of your sites, you shouldn't have an issue drawing blood or using it. Dressings need to be up to date, line should be properly flushed, hubs should be changed, and when drawing scrub the hub and let dry before using.

I draw off of peripherals all the time and have never had skewed results. If you draw it properly without too much pressure on the vein, it shouldn't hemolyze either.

Specializes in Practice educator.

This study suggests its safe and that the result won't be affected by it.

This study shows that it doesn't have a big impact on replacement rates and/or dwell time.

So if you're using evidence based practice you should be trying to withdraw from a cannula ensuring certain techniques.

Obviously look at your policy.

Specializes in Medsurg tele/ICU.

So,when I got to work Tuesday night,my director pasted on the wall that blood can only be drawn from iv site with 18 and 20G only in patients that are hard to stick and to flush with saline,wait 10min ,withdraw 5ml of blood ,waste and draw another one which can now be used for labs.

Specializes in Cardiac Stepdown, PCU.

Wait 10 minutes? Wow. That seems like an excessive amount of time. Make sure you CYA; check hospital policy and then make a progress note each time;

"As per lab request and unit policy, withdrew labs from PIV site (insert procedure details here), patient tolerated well, PIV patent at this time" or something like that. At my facility we need a Doctor's order to draw from any IV line, be it Periph, Mid, PICC... whatever. In the ER and in Ped's I know they draw from the PIV, but once they are admitted and on our floor (tele stepdown) it's a whole new world. The difference being nurses draw the labs in the ER, and in Ped's, and I think in L&D. Every other floor the lab comes and does it. The hospital is working on making things a little more stream line but for now that's how it is. When we do get an order; it's flush, wait about 60 seconds (most wait 2 min), waste, then draw.

For a lot of my patients, by the time the IV is 2 days old (they can stay in for 4 days at my facility) the site wouldn't be viable for blood draw. They're usually not returning blood by then and at that point as long as they are flushing and infusing fine there's no need for us to change it out.

Specializes in Hematology-oncology.

I work in the hematology-oncology world. Most of our patients have central lines, but occasionally they have PIV's. We use the peripheral IV as much as we possibly can for blood draws, especially since many of our patients are difficult to access, are prone to bleeding/bruising, and have labs Q 6 hours.

Edited to add that, as another poster mentioned, our policy states that blood cultures can never be obtained from a PIV.

Yes it matters. Mainly because if you pull back on a peripheral IV site, you'll be starting another one.

It's easier for the lazy lab lady to draw from another site than for you to start another IV.

Specializes in Med-Tele; ED; ICU.
So,when I got to work Tuesday night,my director pasted on the wall that blood can only be drawn from iv site with 18 and 20G only in patients that are hard to stick and to flush with saline,wait 10min ,withdraw 5ml of blood ,waste and draw another one which can now be used for labs.

1) And what defines a "hard stick?" -- one aspect of my job is to start lines and draw labs on patients deemed "hard sticks..." many of whom I can get without any difficulty at all. Am I that good (no...) or are they not really "hard sticks?"

What an asinine qualifier to put into a quasi-official document.

2) Only an 18 or a 20? So you can never draw out of a line on a kid or infant (not to mention the LOL w/ spider veins)? And consider this... your boss is presumably contending that the typical butterfly needle (21, 23, or 25) are not acceptable... and it's inherently illogical to state only an 18 OR a 20... if a 20 is acceptable then everything larger is also acceptable...

Your boss may or may not be aware that arterial lines are most often (in my experience, of course) 22g catheters... and are routinely used for blood draws on critical patients in the ICUs.

3) 10 minutes? This sounds like a random number that's based on sounding nice rather than an objective, data-validated requirement to ensure no hemodilution.

4) Draw and waste 5cc... yeah, that's the first reasonable thing that she's told you... though again, consider pediatric patients whose total permissible daily blood draw can be 5cc.

She is your boss, of course, and you should certainly follow her mandates but don't fall into the trap of setting your career practice on what is arbitrary and invalidated procedure. Keep an open mind, read voraciously, and think... does it make sense? Regardless of the articles and my experience, the notion that you can't draw blood from small catheters or from IV lines has never made sense to me, even when I was brand new and was being told this by a senior nurse... and it's turned out, of course, that it didn't make sense because it was wrong.

Specializes in Med-Tele; ED; ICU.
Yes it matters. Mainly because if you pull back on a peripheral IV site, you'll be starting another one.

Absolutely untrue... and frankly, an illogical assertion from a mechanistic viewpoint.

Specializes in Medsurg tele/ICU.

Hard stick,like 4 nurses trying to get an access with no success and d relative said No to Picc /central line

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