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feeling guilty about blood draw

I know that a good ICU nurse needs to think quickly on her feet. Sometimes, especially if I've gone 10 or more hours without a break, I have caught myself making decisions that were not the best...

I had a situation with a patient taking a turn for the worst and I needed to get a lactic acid blood draw...... Pt had a triple lumen PICC... Blood was infusing into the red port at 100 mL/hour (slower rate d/t risk for overload). Pt didn't have good IV access..... I didn't want to stop the blood transfusion, but perhaps I should have!... At the time, I wanted to stop and ask someone... but sometimes I feel that I am asking TOO MANY obvious questions... In retrospect, I think I should have asked!!

I flushed the blue port with 10 cc saline. Wasted 10 mL blood sample, collected a 10 mL sample, flushed the blue port with saline.........

Now, I'm really starting to wonder whether that lactic acid blood draw was accurate or not!!! Because it was drawn right before shift change, I never got a chance to see the results. I FEEL SO STUPID about this for a couple reasons! 1) It's likely that the sample was the transfused blood and not the patient's!! 2) Should I not be doing all blood draws on the red port!! 3) It is so imperative to have accurate lab results on critical patients!!

bb007rn

Specializes in Emergency room, Neurosurgery ICU. Has 10 years experience.

(((hugs)))) The only way we learn is by asking questions, no matter how obvious they may seem to us! (sometimes, one just experiences what I call a "brain fart") ICU's require teamwork, utilize your teammates, never be afraid to ask a question in regards to patient care.

That said, yes, the result probably was inaccurate.

You should always stop infusions (for approximately 1 minute) when drawing labs from a central line. This was the standard at all the NeuroICU's I worked, though most of our patients had arterial lines to draw from, which was in a word, AWESOME!. I would venture a guess that it is the standard in most facilities.

IV fluids running during a blood draw will give false results, either diluted or in this case inaccurate d/t blood running.

Sorry this happened to you, but learn from your mistake, and you'll never draw from a central line wrong again.

Does your unit have an online policy guide for nursing care? ours did, we also had an over-achiever RN, (whom I loved working with, as he was the fount of all things NeuroICU!), he made "bedside cheat sheets", with our most used policies printed out in binders at each bed in the unit.

If your policies are available online, go through them on a days off/downtime and spend a bit of time reading up on a nursing procedure or two that you are unfamiliar with. After a few days/weeks, they will be more familiar to you.

Best of luck in a very high stress unit. Continue to ask questions, you make yourself better for it!

Thank you so much for your response bb007rn! I know this must sound really stupid to more experienced nurses out there, so I appreciate it. I will definitely learn from this and keep striving for better.

JeanOfAllTraits

Has 2 years experience.

If you have an ART line, draw from there. However if you don't have one, then the PICC or your CVC is your only option besides a typical lab draw. I was taught to pause the other drips before drawimg the waste, them draw the lab, flush and start the infusions back up. If the patient isn't able to tolerate their drips being off thay long then they really should have an ART line anyways. All else fails, find a good vein and try a lab draw your self. :)

bb007rn

Specializes in Emergency room, Neurosurgery ICU. Has 10 years experience.

Not a single one of us "more experienced" nurses has never made some mistake in our careers. None of us are infallible or perfect, but we strive to be as close to it in our practice as we can. We do that by asking questions, even at critical moments. :yes:

Experience is that marvelous thing that enables you to recognize a mistake when you make it again.

- Franklin P. Jones

wanderlust99

Specializes in ICU/PACU. Has 10 years experience.

Next time you're at work, check your hospital policy on drawing blood from lines. My current facility states to pause infusion 2 minutes, waste 5cc not 10. So go with what your hospital wants, many vary slightly.

pennccrn

Specializes in Pulmonary & Cardiothoracic Critical Care. Has 13 years experience.

Just also wanted to send my words of encouragement. We've all had those incidences where we're pressured for time (funny how they always seem to happen at the end of the shift!). I've certainly been there and have taken shortcuts right there with you. Sometimes, I end up regretting it because it just creates more work for me in the end! But I wouldn't be concerned too much about this lactic acid ....

Just my take: Overall, I think its good nursing practice to waste (or use a vamp set-up) and also stop infusions a few minutes before drawing a specimen. This way you know 100% that it was not a specimen contamination issue. Since I have a background as a medical laboratory scientist, I do not think it would have affected the results too much given that the test was a lactic acid. There is a small chance that you might have drawn back the transfused blood into the specimen while infusing the blood (which might have at worst shown a decreased lactate, when a higher one was present). If this had been a CBC, coagulation or a chemistry panel, I might feel differently. Just my $.02 :)

SierraBravo

Has 3 years experience.

It scares the you-know-what out of me when new(er) nurses don't ask questions. Even experienced nurses have questions at times, albeit not as many as when they first started nursing. Please continue to ask questions!!!!! It sounds like you're doing a good job and you're self-aware. I know that all of the literature says that central lines terminate in different places, etc... I've actually seen 2 different brands of PICC's prior to insertion and I can tell you that the one brand definitely separated out the termination points more than the other. So... there is always the possibility of contaminating your blood draw (generally doesn't matter which port you draw from, unless you are drawing a level for something and you are drawing that level from that port in which the drug was infusing) unless you pause all of the other infusions going into the line AND clamp the lines to ensure that no backflow occurs. I follow this rule for PICC's, IVAD's, TCVC's, etc...

mcubed45

Has 5 years experience.

Never really understood the rationale for pausing drips for several MINUTES before drawing. The catheter's sitting in the vena cava. CO is 4-8L/min. Even if you're drawing from the most distal port, it only takes a couple seconds for the 'upstream' IV fluids to get carried away.

Thanks again for all these helpful comments. I really appreciate the advice as I am finding myself doing a lot of blood draws from central lines and this is new for me!!

sallyrnrrt, ADN, RN

Specializes in critical care, ER,ICU, CVSURG, CCU.

keep on keeping on, we need you :)

keep on keeping on, we need you :)

Ah, thanks Sallyrnrrt. Really appreciate your kindness and understanding of the newbie ICU nurse :)

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