Drawing from Previously existing IV?

[js6522]

Hi all!

Im an RN at a level 2 Trauma Center on the Surgical and Pediatric unit (all ages surgical, all of the stable peds, and we get the traumas that are stable as well.)

I recently shadowed at a hospital that my organization acquired on the peds unit and noticed they draw off of peds IVs and return the waste to the patient whereas we only draw off of central lines and I've never seen waste returned.

what is best practice? What do other hospitals do? What research is out there?

[PixieRN1]

In my peds experience (15 years), if the IV was able to draw, we would always draw from the IV to avoid another stick to a child. Healthy kids are a challenge to stick regardless, so avoiding a stick on a compromised child is best practice.

As for returning waste, again, in peds, it is standard practice to return the waste; their blood volume is much smaller than an adult and a 10 cc waste is a big deal for the smaller peds.

The only absolute contraindication to drawing from an IV would be a blood culture; you gotta stick for that. But in peds, they also accept smaller blood volumes for many routine labs and blood cultures (i.e. do not take 5 mls of blood from a 4 kilo baby for a BC. 1 ml is the minimum needed and will trip a positive just fine if the baby has bacteremia. You can run a BMP and microbili on 0.5 ml of blood if you use a green pedi bullet as well...that sort of thing).

All that being said, in smaller peds with small gauge IVs, it's often impossible to draw from a patent IV site. If the site is older, even with a larger gauge, while it may flush just fine, it may not draw.

If you are able to draw labs from an IV, I would do it in a heartbeat. Just be aware of the labs that you can and cannot use a tourniquet on.

Very common practice! Hope that helps!

[js6522]

Thank you so much! Any chance you could send me a copy of your hospital's policy on that? The more proof I have the easier I'll be able to implement a change.

[PixieRN1]

Thank you so much! Any chance you could send me a copy of your hospital's policy on that? The more proof I have the easier I'll be able to implement a change.

I would in a heartbeat if I was in peds still. I left that facility and now work at a different facility in Psych, just this year.

I still have many friends and contacts who work there obviously, so I can ask them if they can pull a copy of policy. I worked in PICU there. I'll see what I can do.

[PeakRN]

We draw off established peds IVs, but I never have seen or personally would return the waste. You only need to waste about 3 times the priming volume of your angio/extension set (make sure that you have a policy that supports this), and by no means should need to waste 10 mLs.

We don't have a formal policy at my current hospital but at my past (level 1 pediatric only trauma center) any patient who was expected to have blood drawn every 6 hours or more frequently and was over 2 years of age could have an IV placed simply for the purposes of blood draws, this IV was to be a 20 gauge (or larger in teens) in the AC or Saphenous.

[PixieRN1]

We draw off established peds IVs, but I never have seen or personally would return the waste. You only need to waste about 3 times the priming volume of your angio/extension set (make sure that you have a policy that supports this), and by no means should need to waste 10 mLs.

We don't have a formal policy at my current hospital but at my past (level 1 pediatric only trauma center) any patient who was expected to have blood drawn every 6 hours or more frequently and was over 2 years of age could have an IV placed simply for the purposes of blood draws, this IV was to be a 20 gauge (or larger in teens) in the AC or Saphenous.

You are correct about the typical waste volume. However, in our PICU, if TPN was running in a line with pressers that could not be paused for ten minutes, we were required to take a large waste and then return it.

[IVRUS, BSN, RN]

You are correct about the typical waste volume. However, in our PICU, if TPN was running in a line with pressers that could not be paused for ten minutes, we were required to take a large waste and then return it.

First, why are you stopping your medication(s) and then waiting TEN MINUTES. That is crazy, imo. The blood flow running through the SVC is over 2000mls/minute. Two minutes is standard practice, btw.

Secondly,

If the syringe with the waste is detached from the IV catheter, one must NEVER reinfuse it. SO, I am assuming that you are using the mixing method, right?