Drawing Labs from a New Start??

iluvivt, BSN, RN · May 14, 2009

No...it will not damage the vein...what damages veins is all the stuff we put through them..especially those things with a ph of less than 5 and greater than 9 and those with high osmolalities.........Now perhaps the nurses are drawing improperly from them and they are hemolyzing the sample....if you pull too hard ...sure it can happen...not all initial IV sites can be drawn from for a variety of factors...then I just save my line and perform a standard venipunture for labs........ After a PIV has been placed and has been used...being used...or is locked off...it should not be used...but start the IV...do your draw and then use it.....that is all OK and within accepted practice and does NOT violate the standard of care....I do it every day I work

salpal92 · May 15, 2009

My understanding is that it will hemolyze if you draw from a small gauge catheter. Less than 22g.

I do it frequently at my job as well. We give short term infusion in an outpatient center. So normally we will use a 24g cath for comfort, but if I know I am to draw labs, I will place a 22g. Our lab has never called with any problems with the specs I have drawn.

ECUPirateRN · May 16, 2009

I work in Pediatrics and our IVs are very frequently either 22s or 24s. Sometimes we can get bood from a 24 with no problem, even a day or so after the PIV was started. Sometimes we can't and we have to stick the kid. Sometimes it comes back hemolyzed and sometimes if we try to hard to get blood from the PIV we end up messing it up and can't flush the line, which is why if I don't have decent blood return I don't try too much harder for fear of losing the line. But I have never heard of blood draws from a PIV messing up the vein. I hope this isn't true..I hate sticking the kids any more than we have to!

iluvivt, BSN, RN · May 17, 2009

You can draw from any gauge.......just have a couple of different syringe sizes available so if blood is coming slow....you can draw..transfer to tubes...draw some more with a new syringe....and transfer again....IF you pull to hard and the blood and syringe start vibrating....you are drawing and pulling too hard and that is one way it can hemolyze...and also if it takes you forever to get the volume you need and you have a large syringe..and thus the suggestion to use several smaller syringes (if blood return is coming but slow)....and NO...it WILL not harm the vein to draw blood with and intial venipuncture.....not only are you saving the patient a stick you are preserving the other veins......you are also preventing potential infiltrates.....if you draw labs in the ACF and then start an IV below the ACF...it can potentially leak out the hole you made in the vein upstream,so to speak and infiltrate or extravaste in that area....so you see many times (especailly with drugs like Dopamine and levophed) it is prudent to draw this way OR perform stick for lab in one arm and IV in other.....and yes this can happen,,,I have seen it with chemotherapy a few x...it was not pretty

ECUPirateRN · May 17, 2009

Thanks for the insight. Sometimes we do exchange transfusions on our kids with sickle cell and we try and get a large enough IV to get blood from it easily. It is ideal to use the larger syringes to draw the blood but sometimes we just can't get blood from the line with a 10mL syringe and have to use several 5mL or 3mL syringes instead. We try and have 2 PIVs if we do an exchange so we can pull from one and have whatever is going (b/c they are usually on a morphine PCA due to the pain crisis) going through the other.