Intravenous blood draws

vamedic4, EMT-P · Jan 19, 2007

What kind of information are you looking for aleanth?? We draw blood from PIVs here...I'm just wondering what it is you are needing to know.

vamedic4

aleanth · Jan 19, 2007

basically i have some resistance from nurses about drawing from PIV's. There is not a lot of literature about it, the infusion nursing standards for 2006 mention to only use it on the initial insertion and for less than 48 hours. This is however adult based. I was curious if other put a time limit for when you can draw from it? and any other protocals you may have. We do not have actual protocals but we created a competency and for the staff. I am looking for any info you are willing to share. :nurse:

kidsRN5 · Oct 23, 2007

I would like to know what size IV you use and the procedure for drawing off the IV's i have found half the time I am unable to get blood return

Pediatric Critical Care Columnist · Oct 23, 2007

I don't often have much luck drawing from an established PIV either. The ones I have the best luck with are the 20's, but of course they'd be in bigger kids, and usually have other options. Thank the lord for art lines, PICCs and CVCs!

elizabells, BSN, RN · Oct 23, 2007

In the NICU (I'm responding here bc sometimes you have babies in PICU) we never withdraw once an IV is in, but on initial insertion of a 24g (all we use) if we need blood we'll let the backflow drip out and fill the microtainers, or sometimes put a small needle on a syringe and aspirate the backflow from the, um, wider part of the... you know, the cone-shaped bit behind the catheter? :uhoh3: But we never directly draw off a PIV. FWIW, a variation on that trick can work with a pokey P-Art line - stick a 23g needle in the port on the T-connector (or wherever you would normally draw your bloods from), attach another needle to a syringe, and aspirate up the drips. Sometimes you can use an art line for an extra shift or two that way.

RNNPICU, BSN, RN · Oct 25, 2007

The only time I attempt to draw off a PIV is if the pt has an 18 or 20 gauge in, however if they are a difficult stick, I leave it alone and only have my IV fluids and meds going through. Art lines, PICCS and CVLs are the best places to draw. SOmetimes if the pt is going to be in the PICU for a while I will ask for a CVL or Art line to be placed

vamedic4, EMT-P · Oct 27, 2007

Drawing blood off small (24 gauge) catheters can be done, but it's tricky. And you have to weigh the benefits and risks.

Do we need this blood bad enough to risk losing the IV?? Is it going to be difficult to establish other access if we ruin this IV by drawing blood from it??

If you HAVE to do it, flush it with some saline first. Then tie a tourniquet above the IV site as you would if you were starting an IV. Get yourself a 5 cc syringe and a needleless catheter (the larger the hole the better) or a 23 gauge needle. Draw off at least 2-3 cc of waste and get rid of it. Then get a fresh syringe and needleless device or needle and draw off only as much as you need to do your testing. Don't forget to flush the IV again with saline and heparin per your institution's policy.

You occasionally have to manipulate the IV site while drawing blood, so this procedure is DEFINITELY not adviseable on patients who's IVs are "iffy" at best, or if you are one breath away from breaking open a crash cart on them.

vamedic4

nurseiam · Oct 27, 2007

I am in the float pool. We draw from any PIV that will. Depending on the situation I may attempt to draw from a 24g but those are risky. We use mostly 22g and it just depends some nights when I am doing IVT they all draw, some nights none of them do! It saves a lots of tears, pokes and time!

Semele · Nov 9, 2007

I will only draw from the initial stick, like others have said. There is usually a good reason for the iv and it needs to be maintained over lab draws. Besides a heel stick or finger stick can get most of what is needed.

pcicurn7 · Nov 16, 2007

Most kids in our PICU have art lines...so this is usually not an issue.

If our kids come up from the ED, i know the nurses there will insert two PIVs, one for infusions the other for draws. in this case, they usually put in a 20g or 22g. Drawing from this PIV is usually short term...I've seen very abnormal results from blood taken off a PIV, so its definitely not ideal....it really depends on the situation.

If these kids are very, very ill (as they usually are if they come to us from the ED), their PIVs wont matter, they buy themselves an art line the moment they get up to the unit.

Semele · Nov 16, 2007

Most kids in our PICU have art lines...so this is usually not an issue.
If our kids come up from the ED, i know the nurses there will insert two PIVs, one for infusions the other for draws. in this case, they usually put in a 20g or 22g. Drawing from this PIV is usually short term...I've seen very abnormal results from blood taken off a PIV, so its definitely not ideal....it really depends on the situation.
If these kids are very, very ill (as they usually are if they come to us from the ED), their PIVs wont matter, they buy themselves an art line the moment they get up to the unit.

I would never put in a 20g specificly for lab draws, knowing how short term it will be and the possibility of collapsing tiny, obviously needed veins.I will do art sticks or even finger/toe sticks to get the lab rather than using a piv. Plus if one nurse draws from the piv and the next sticks the kid..the parents get very confused about why we would choose to stick when the other nurse didn't.

What policies do you all have regarding drawing from lines? Our facility even requires a doctors order to draw from PICC lines. We do it frequently but only if said order is on the chart.