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.
Specializes in Infusion Nursing, Home Health Infusion.
It is considered acceptable practice to draw blood immediately 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 active 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 advised to avoid blood draws,again this is to promote the maximum dwell time and keep the infection risk lower.
I work in the ED. We generally placed a INT in patients and then draw labs from it. We do have alot of problems with hemolyzed specimens causing a delay in reporting due to recollections.
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.
Here's what I do in my ED:
* Before you begin, have the Vaccutainer holder (that clear plastic thingie into which you shove tubes. I'll try to see if I can post a picture LOL) with the Blue-hub BD (has the clear opening on one end and the black-covered needle the other end). Connect this contraption to the hep-lock (push the clear end of the holder/needle into the hep lock)
* Insert peripheral IV as you normally would.
* Leave tourniquet in place
* Using finger of non-dominant hand, apply strong pressure an 1" - 1.5" above the hub of the IV to occlude the vein.
* Pull needle out, leaving the IV catheter in place. You now have peripheral IV access.
* Hook up the pig-tail (with vaccutainer holder attached) to the hub of the IV
* Simply insert tubes as you normally would with a peripheral stick and draw blood :) Some nurses like to draw off a waste tube first.
* When you're done drawing blood, disconnect the holder from the saline lock.
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.
What if the peripheral is not running anything (just saline locked)? Does your facility allow blood draws if the IV is not otherwise being used?
Using an active 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 advised to avoid blood draws,again this is to promote the maximum dwell time and keep the infection risk lower.
ok... so whenever you access a PIV you are increasing the risk of infection - I get that. But why would a blood draw increase the risk of infection more than just hooking up a piggyback or running a primary?
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.
We don't disconnect it. Our IVs have like a hub at the base, so we just pause the infusion and draw off the second port-type thing at the hub.
Specializes in Infusion Nursing, Home Health Infusion.
Using a PIV for routine blood draws does increase the infection risk as blood tends to stick to various parts of the infusion system,especially the caps. Do you know how blood sometimes will fill the IV tubing if the patient raises their arm or the IV bag goes dry or there is an inadvertent disconnection...you are even supposed to change the tubing then if you can not adequately clear the line so you can no longer see the blood. Also by not using PIVs for blood draws you are promoting venous preservation b/c using the line for that purpose decreases the dwell time. In certain situations it is acceptable to place a dedicated PIV for blood draws. We used to do this on our neuro study patients since the research criteria was very strict about the blood draw times.
Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.
We only draw off peripheral IV's w/ the start, not indwelling heplocks or saline locks. I usually just use a 10 cc syringe and screw it directly on to the jelco to draw before hooking up extention tubing etc. I like to be able to control the draw especially with fragile veins, small jelco's, and can't do that w/ a vacutainer- I would hate to blow the IV for the sake of the labs. Of course we also draw our labs off ports, TLC's, PICC's and we can use Midlines as well
Specializes in Oncology/Haematology/Stem Cell Transplant, Med/Sur.
Interesting debate, actually blondy2061h do you draw bloods from a central lines using vaccutainers or do you use syringes ie 10cc & 20cc? We use both in Australia. I find picc's to be very temperamental at times.
were I work ,(PEDS)we now draw labs off the PIV(some research available).Big controversy going on about ?????Returning the waste blood.????
I researched this (returning of waste) and my conclusion ( Evidence Based Practice) is that returning of waste on PIV's has not been researched at all (Association of Vascular Access and Infusion Nurses Society). Apparently this pracice is common in PICU area's.......still not evidence based practice....If low blood volume is of concern AVA recommends other means (I STAT,Finger-heel stick,butterfly)to collect labs.
iluvivt, BSN, RN
2,774 Posts
It is considered acceptable practice to draw blood immediately 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 active 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 advised to avoid blood draws,again this is to promote the maximum dwell time and keep the infection risk lower.