Blood specimen from iv sites.

Nurses General Nursing

Published

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?

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

What's your rationale for this?

Specializes in ICU.
Excuse this oldy moldy. Back in the day... any peripheral site was changed in 72 hours. My thoughts still remain that the chance of infection is present, without obvious signs. Wonder if an infection control nurse could chime in.

Our hospital recently switched from a 96 hour IV site policy to an "as long as it's working" policy. They said it's new evidence based practice that they don't need to be swapped out. The exception for us is if it's an EMS/field stick. Those are still a 96 hour site change.

Also unless you were drawing blood cultures I wouldn't worry about drawing off a PIV if it gives good enough blood return. Just make sure you flush it well after.

AAAAAAH! The amount of rage I have for this topic! Sorry, not yelling at you, just the whole, "You can't draw from an IV". Though, it is perfectly fine to pull from a PICC or Mid? I've worked in an Hospital setting for six years, not once has a blood draw off an IV ever come back contaminated or a false positive.

I now work at a hospital that has strict rules from pulling labs off an IV. One night, lab tried to get blood work off one of my patients and stuck them multiple times with no success, even though they have an established IV. They notified me that we needed to call the Doc to have a PICC inserted! I was so infuriated, that the patient has gone through all this, when it could been drawn off the IV? Now, they need a PICC? I asked co-workers what the policy was for drawing off an IV (I am new to the facility)? They said, "'Technically, we aren't suppose to'". I laughed and did it anyways. Surprise, labs came back unhindered and caught a critical value.

Specializes in Med-Tele; ED; ICU.
AAAAAAH! The amount of rage I have for this topic! Sorry, not yelling at you, just the whole, "You can't draw from an IV". Though, it is perfectly fine to pull from a PICC or Mid? I've worked in an Hospital setting for six years, not once has a blood draw off an IV ever come back contaminated or a false positive.

I now work at a hospital that has strict rules from pulling labs off an IV. One night, lab tried to get blood work off one of my patients and stuck them multiple times with no success, even though they have an established IV. They notified me that we needed to call the Doc to have a PICC inserted! I was so infuriated, that the patient has gone through all this, when it could been drawn off the IV? Now, they need a PICC? I asked co-workers what the policy was for drawing off an IV (I am new to the facility)? They said, "'Technically, we aren't suppose to'". I laughed and did it anyways. Surprise, labs came back unhindered and caught a critical value.

Recently I've prevented three needless PICC lines by placing a GOOD peripheral IV with ultrasound guidance which lines were sufficient for drawing blood as well as infusions.

The illogical basis of this claim drives me bonkers...

Specializes in Practice educator.
Our hospital recently switched from a 96 hour IV site policy to an "as long as it's working" policy. They said it's new evidence based practice that they don't need to be swapped out. The exception for us is if it's an EMS/field stick. Those are still a 96 hour site change.

Also unless you were drawing blood cultures I wouldn't worry about drawing off a PIV if it gives good enough blood return. Just make sure you flush it well after.

Exactly.

This review says do away with the 5 day rule (We still have this in the trust sadly)

There is ZERO evidence to support cannula removal purely on the basis of time.

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

I think the point of the post to which you are responding is that "hard stick" is a completely meaningless term. I am good at IVs because I do a lot of them. In addition to my own patients, I am a resource for others, which has also helped my skills.

So, if the floor can't get an IV after multiple times, they might call the ER, and I might go up. I might look at that big fat vein on the posterior forearm that people often over look- the one where you sometimes have to have the PT put his arm over his head, or some other mild contortion. I might stick an 18 in there, no problem. So- was that a hard stick?

Yesterday, a newer ER nurse missed twice. I started a 22, which drew easily. So, even if I called that easy stick "hard", I would have had to toss the perfectly fine sample. On the other hand, if New Nurse had not been working, I might have gone in and easily inserted a 20. The needle size would have been ok, but the fact that it went in easily would have forced me to chuck the sample so the lab could come up, stick her again, and draw- probably with a 22.

"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."

  • As noted- 18 or 20 gauge minimum is made up, plain and simple. This idea that an adult red blood cell can't squeeze its way through a 22 gauge lumen is a myth of mythic proportion which not only has no evidence, but is disproven every day.
  • Not only is the term "hard stick" meaningless, the idea allowing draws from hard sticks only defies logic and evidence. Hemolysis is more likely with a hard stick, which actually favors blood draws from easy sticks.
  • Wait 10 minutes. Why? Is their some thought that saline pools in a vein for nine minutes? Maybe the valves are on teeny little timers?
  • Assuming a priming volume of

This policy is so wrong, it is impressive. Assuming it was hung right side up, with the ink facing outward, that would be the only thing right about it.

I occasionally get a family that thinks that a PIV site is an all access central line.

I work in pediatrics. Is it worth trying to get a CBC from the 24g in my 6month old patient's chubby hand? I mean, maybe. But my experience has shown me that 1) the chances of losing the site are absolutely real and 2) most of them don't give back blood anyway unless they are a nice fat 16/18 in a teenager. I am not going to risk my one PIV access in a baby to avoid a stick.... mostly because an IV start is a heck of a lot more painful to my patient than a ten second lab draw. Nope, nope, nope. You can show me 5683736827 EVP papers that show that pulling back on an IV doesn't increase the risk of blowing the site, and I will show you physical evidence of me blowing the site after attempting to get a stupid CBC the lab was too lazy to draw. Now, if there are multiple sites? I will definitely give it a go. ONLY after flushing and making sure all my sites are WORKING. I'm telling you, I've been burned. And nothing pisses off parents more than you telling them they have a PIV so we won't have to stick them for labs anymore, then not being able to pull a lab off the PIV, then losing the site, and having to restart said PIV. :/

I have real beef with the RNs and techs that make those kinds of BS promises to families in the ED.

As for rotating sites, we use them until we can't use them anymore. That's a housewide policy, even in the adult world. (The good news is most of my kids are out in less than a week anyway - and if they aren't, and are getting serious IV ABX, etc - they are getting a PICC at that point anyway.)

Specializes in Med-Tele; ED; ICU.
And nothing pisses off parents more than you telling them they have a PIV so we won't have to stick them for labs anymore, then not being able to pull a lab off the PIV, then losing the site, and having to restart said PIV.

I can tell you something that really pisses off the parents...

Me walking into their room and drawing a specimen from the existing IV after multiple unsuccessful sticks by the floor nurses.

I'm curious: What's your proposed mechanism behind how pulling blood from a lie might make it fail?

+ Add a Comment