On our floor most of our patients have central lines (it's rare to have even one patient on the floor without one). Since we draw off the lines, phlebotomy doesn't even come to our floor. We do all of our own blood draws. If we do get a patient with a peripheral IV, we will generally try and draw blood off of the peripheral IV before resorting to sticking them.
However, last time I was in the hospital, I was stuck every single time they needed blood- which was often 3 times a day.
In the nursing homes I've worked in, we only drew from PICC's or central lines...and when we did have phlebs come in to draw, they would always draw straight from the arm (not the saline locks or IV's). However, maybe phlebotomists aren't supposed to draw from IV's, PICC's, or central lines.
Specializes in Trauma ICU, Surgical ICU, Medical ICU.
We draw off peripherals all the time, we usually just do the 5cc waste. Sometimes the samples are hemolyzed but usually if its done slow enough thats not a problem. We have no troubles with tainted labs. Our unit tries to keep central lines out of patients d/t infection risk, so we use peripherals as much as possible in our ICU. We are stringent with removing triple lumens after 3-4 days,changing PIVs after 5 days, and only giving PICCs to those who desperately need them, if a patient is doing well and will most likely be leaving the ICU in 1-2 days, they dont get one. It seems to work, we usually have a great score when it comes to infection control. I've never heard anything about erroneous labs with PIVs.
What is the rationale at these facilities that say it's "against policy?"
If you draw too quickly or pull back with too much force, you can blow the IV. I can see how you can get tainted results if you don't waste. But either situation can be avoided with correct technique.
However, maybe phlebotomists aren't supposed to draw from IV's, PICC's, or central lines.
Correct, it's outside their scope of practice. I'm not even sure if it's in an LPN's scope of practice. The nurse has to be doing the blood work if this method is being used.
We draw off peripherals all the time, we usually just do the 5cc waste. Sometimes the samples are hemolyzed but usually if its done slow enough thats not a problem. We have no troubles with tainted labs. Our unit tries to keep central lines out of patients d/t infection risk, so we use peripherals as much as possible in our ICU. We are stringent with removing triple lumens after 3-4 days,changing PIVs after 5 days, and only giving PICCs to those who desperately need them, if a patient is doing well and will most likely be leaving the ICU in 1-2 days, they dont get one. It seems to work, we usually have a great score when it comes to infection control. I've never heard anything about erroneous labs with PIVs.
Wow! We leave central lines in for months. What about administering things like TPN? If they need TPN do they get a new central line every 4 days? What about art lines? I would be more concerned about consistently measuring things like pressors peripherally or losing access if a person starts crashing than infection, I think. I'm not sure I'd be comfortable having a critical patient with no central access.
If you draw too quickly or pull back with too much force, you can blow the IV. I can see how you can get tainted results if you don't waste. But either situation can be avoided with correct technique.
Hmmm, I've never seen an IV blown. Normally, if you have a good vein, you don't even need to pull back, it just flows in on its own. Often our peripheral's will quit giving a blood return before the go bad.
Specializes in Trauma ICU, Surgical ICU, Medical ICU.
Wow! We leave central lines in for months. What about administering things like TPN? If they need TPN do they get a new central line every 4 days? What about art lines? I would be more concerned about consistently measuring things like pressors peripherally or losing access if a person starts crashing than infection, I think. I'm not sure I'd be comfortable having a critical patient with no central access.
Yep, I wasn't too comfortable with it. Personally I thought it was kind of rediculous as I think keeping the pt alive and having access is better than infection control but our admins are soooo proud of our infection control scores so thats how it's done. We hardly EVER do TPN (I've seen it done maybe twice) for infection control reasons. Art lines stay in if the pt isn't going anywhere fast, but we try to get them out ASAP and monitor with a cuff. I usually wait till the last possible second to pull them because it seems that the pt ALWAYS crashes once theyre out and we've just gotta put em back in. PICCs are still placed but its like an act of congress to get them. I absolutely hated having a pt with no central access!!!
When I was an IV therapist I always checked to see if any labwork was ordered or due before starting someone's IV. If so, I drew off the blood before connecting the IV lines or capping the IV as a saline lock. When I worked night shift, I was especially alert for this as I was doing re-starts after 4am. If we got called to start an IV in the ER we always drew off blood for labs before hooking up the IV.
Also, saline locks were used for lab drawing in pediatric children who were having serial blood sugars. A saline lock was also in place for lab draws on CCU patients who had received tPN.
Can you spell out how you do this? I guess after getting your IV in you pin the vein down with one hand and connect the little little plastic thingy to the hub of the IV cath with the other hand. Do you do this before stabalizing the IV? Sounds like it could be tricky.
In our ED, they will draw labs when a peripheral is first put in. Otherwise, we only draw off of PICC's and other central lines. Infection control risk of disconnecting a running PIV to draw blood.
On my peds unit, if there are labs ordered, we will almost always draw from the PIV. The only cases we don't if we are doing blood cx from multiple sites or on some of the older "peds", 17-19yo that have easier veins/better tolerance. We always just flush the line with 3-5cc the pull back 3-5cc of waste. Never had a problem with any tainted labs. And makes for much happier kids.
Specializes in Infusion Nursing, Home Health Infusion.
It is considered acceptable practice to draw blood immediatly after an IV start. Once an IV is being used for any type of Intravenous therapy it is no longer acceptable to draw from these lines. Ii is acceptable to establish a peripheral for the sole purpose of obtaining blood samples and this site needs to be below any IV being used for intravenous therapies. Using an actrive peripheral for blood sampling increases the risk for infections,may lead to inaccurate draws and does not promote venous preservation as the sites tend not to last as long. Even with midlines it is adviced to avoid blood draws,again this is to promote the maximum dwell time and keep the infection risk lower.
mondkmondk
336 Posts
In the nursing homes I've worked in, we only drew from PICC's or central lines...and when we did have phlebs come in to draw, they would always draw straight from the arm (not the saline locks or IV's). However, maybe phlebotomists aren't supposed to draw from IV's, PICC's, or central lines.
Blessings, Michelle