How is lab collection treated in your unit?

BittyBabyGrower, MSN, RN · Jun 18, 2006

We do all our own labs. Most of our labs are 0.5mls (CBC/diff, BMP, BNP, med levels, X/type), some are 1 ml such as complete hepatic panel with basic met. panel, coags. Our ABG's are either done with an inline monitor that wastes no blood, or in our lab and that is 0.3ml. Genetics and metabolic studies are usually a lot, like 2-5 mls.

I'm in the north :)

lovemyjob · Jun 18, 2006

Also in the south, we also do our own labs. 0.5 for a CBC D/R/P and about 0.6 for a BMP, T&D Bili, mag, po4, tg, drug levels, CRP, 0.5-1 for a culture, 2 for a ype and screen. Have heard of a CMP with a very full gold top microtainer. Um... oh. ABG's are .3-.4, more if they need an iCa and we only do ABG's when very ill unless they have an art line. WAe can do art sticks in one of the states I work, so when we have sepsis workups, it is not as hard as blowing all of your veins for all that blood. The other state I work in does not allow art sticks (which I DO NOT understand.) Also the other hospital I work in has lab draw all of the blood from heelsticks for AM labs and other scheduled labs. I dont like this at all because I have found too many sticks in the no-no zone, and I feel like I can do it with less trauma to the tissue. Some of the nurses at the larger hospital I work in actuallty use one o the 24 g needles (the brown ones) one hits one of the veins in the had and lets the blood drip into the microtainers. This seems least traumatic on the babies. I am going to start giving it a try.

unikuelady, RN · Jun 18, 2006

[ Some of the nurses at the larger hospital I work in actuallty use one o the 24 g needles (the brown ones) one hits one of the veins in the had and lets the blood drip into the microtainers. This seems least traumatic on the babies. I am going to start giving it a try.

In my facility the nurses obtain their own labs. Some of our nurses will obtain lab samples via the vein as above.....but...we have found that we are losing potential iv sites by this practice. We only use UAC/UVC on the sickest kids, and PIVs for the rest. To help reduce "hamburger foot" We use the lancets for lab draws only. Accu checks can be done from the big toe with the tiniest prick of a needle. We also only keep babies >1500gms.

LaNICUnurse · Jun 18, 2006

Also in the south, we also do our own labs. 0.5 for a CBC D/R/P and about 0.6 for a BMP, T&D Bili, mag, po4, tg, drug levels, CRP, 0.5-1 for a culture, 2 for a ype and screen. Have heard of a CMP with a very full gold top microtainer. Um... oh. ABG's are .3-.4, more if they need an iCa and we only do ABG's when very ill unless they have an art line. WAe can do art sticks in one of the states I work, so when we have sepsis workups, it is not as hard as blowing all of your veins for all that blood. The other state I work in does not allow art sticks (which I DO NOT understand.) Also the other hospital I work in has lab draw all of the blood from heelsticks for AM labs and other scheduled labs. I dont like this at all because I have found too many sticks in the no-no zone, and I feel like I can do it with less trauma to the tissue. Some of the nurses at the larger hospital I work in actuallty use one o the 24 g needles (the brown ones) one hits one of the veins in the had and lets the blood drip into the microtainers. This seems least traumatic on the babies. I am going to start giving it a try.

I do this also, and if you become skilled with it, it is very less traumatic to the infant. Not good for anything that has to go in a vacuum tube though.

lovemyjob · Jun 18, 2006

[ Some of the nurses at the larger hospital I work in actuallty use one o the 24 g needles (the brown ones) one hits one of the veins in the had and lets the blood drip into the microtainers. This seems least traumatic on the babies. I am going to start giving it a try.

In my facility the nurses obtain their own labs. Some of our nurses will obtain lab samples via the vein as above.....but...we have found that we are losing potential iv sites by this practice. We only use UAC/UVC on the sickest kids, and PIVs for the rest. To help reduce "hamburger foot" We use the lancets for lab draws only. Accu checks can be done from the big toe with the tiniest prick of a needle. We also only keep babies >1500gms.

I could def see where this would be a problem. We very rarely have PIV's, and if we do we are waiting on a PICC. How long do your kids usually stay on the unit?

unikuelady, RN · Jun 18, 2006

I could def see where this would be a problem. We very rarely have PIV's, and if we do we are waiting on a PICC. How long do your kids usually stay on the unit?

We have had preemies on TPN/LIPIDS for up to 2 weeks. If we are lucky a PIV site will last 24 hours. Most of the time tho we need 2 sites at all times, 1 for the IV fluids and 1 for the antibiotics. Our poor babies are subjected to multiple IV sticks-almost on a daily basis :scrying: I have yet to hear a satisfactory answer as to why we do not use PICC lines. :banghead:

dawngloves, BSN, RN · Jun 21, 2006

A sepertate line for abx? Most are compatable with TPN.Off the top of my head I think only ampho needs a seperate line.

Gompers, BSN, RN · Jun 21, 2006

A sepertate line for abx? Most are compatable with TPN.Off the top of my head I think only ampho needs a seperate line.

We actually run Ampho through our main line - like if the baby has a PCVC or PICC we'll use that for everything - usually if they have yeast they're as sick as dogs anyways and access sucks. We'll do the Ampho over four hours, flushing the line before and after with 1cc of D5W. Then we'll run the TPN over the remaining 20 hours of the day - we'll divide what the baby needs for fluids over that 20 hours. It makes having to give Ampho a bit easier!

We do all our own labs - no RTs, nurses' aides, or lab personell are allowed to poke our babies!!!

We have a machine on the unit that does blood gasses, glucose, electrolytes, and hematocrit - for this machine we only need 0.2-0.3ml of blood. We need 0.5ml for CBCs and bilirubins. For things like metabolic panels, liver function tests, and peaks/troughs we need 0.7ml. Coags are 1.8ml. Type and scree is 1.5ml. Blood cultures are 0.5-1ml.

If there is no arterial line (UAC or PAL), then we'll usually do heelsticks. If we need a lot of blood or something like a culture, we do our own arterial sticks with 25 gauge butterflies. We never do venous sticks because they often ruin the poor viens and we need them for IVs. If I'm just doing an accu-check, I'll grab a 24 gauge needle and just lightly touch the heel with it, and this is usually enough to get that one drop of blood I need.

EricJRN, MSN, RN · Jun 21, 2006

I have yet to hear a satisfactory answer as to why we do not use PICC lines.

I suspect it's because your docs hate inserting PICC's. They're great once they're in, but I have never heard such a barrage of foul language and frustration as when an MD or NNP is attempting to insert a PICC line.

lovemyjob · Jun 21, 2006

Our nurses do PICC's. I dont think our docs even try. It is great that they can do them because they can do it all shifts (there is always a picc nurse there) so if days doesnt get it nights can try. Plus, if one breaks or stops working, the nurse can do the repair or removal.

Gompers, do you run D5 carrier fluids with your ampho to keep the line open and to help with fluid/glucose needs?

LaNICUnurse · Jun 21, 2006

We actually run Ampho through our main line - like if the baby has a PCVC or PICC we'll use that for everything - usually if they have yeast they're as sick as dogs anyways and access sucks. We'll do the Ampho over four hours, flushing the line before and after with 1cc of D5W. Then we'll run the TPN over the remaining 20 hours of the day - we'll divide what the baby needs for fluids over that 20 hours. It makes having to give Ampho a bit easier!
We do all our own labs - no RTs, nurses' aides, or lab personell are allowed to poke our babies!!!
We have a machine on the unit that does blood gasses, glucose, electrolytes, and hematocrit - for this machine we only need 0.2-0.3ml of blood. We need 0.5ml for CBCs and bilirubins. For things like metabolic panels, liver function tests, and peaks/troughs we need 0.7ml. Coags are 1.8ml. Type and scree is 1.5ml. Blood cultures are 0.5-1ml.
If there is no arterial line (UAC or PAL), then we'll usually do heelsticks. If we need a lot of blood or something like a culture, we do our own arterial sticks with 25 gauge butterflies. We never do venous sticks because they often ruin the poor viens and we need them for IVs. If I'm just doing an accu-check, I'll grab a 24 gauge needle and just lightly touch the heel with it, and this is usually enough to get that one drop of blood I need.

We do the same with Ampho. We also have some nurses that are trained to put in PICC's. We love them, and are beginning to use the new 2 port catheters. Also, we just yesterday began trialling the in line ABG machine, on one of my babies. I love it!!!! It told me quicker than our RT that my baby needed help.