IV starts and drawing blood

NurseforPreggers · Jun 26, 2005

I'm not an ER nurse, but all of my patients get blood drawn on admission. We start the IV and connect a syringe to the catheter of the IV and draw blood, remove the syringe of blood and connect the IV tubing to the catheter. No need for 2 sticks usually unless the blood won't come but the IV site is good.

ERNurse752, RN · Jun 26, 2005

Draw blood from the IV. Sometimes if it's a small gauge it won't work, but usually it does.

Dixielee, BSN, RN · Jun 26, 2005

This procedure is routine where ever I have worked. It saves the patient sticks and saves you time. My procedure is to cannulate the vein as usual, then connect an unflushed 7 in. extension line to it. Tape the needle down, but do not completely dress it as sometimes you may need to manipulate it a bit. I then connect my vacutainer or syringe (vacutainer makes it less likely to get blood spills and you never come into contact with a needle), and connect my tubes. Our blood culture bottles fit into the vacutainer as well, but you need to prep the skin for cultures if you plan on them. Once my tubes are filled, I flush the tubing with saline, cap with saline lock and then hook up my fluids. That way, if you need to change tubing etc. later, you do not have to manipulate the catheter. I found it you do not use the extension tubing when you draw, you risk losing your line as you change syringes or tubes, especially if it is a small gauge catheter. If the patient moves or jumps, you are already in a relatively secured line with tape.

Happy-ER-RN, RN · Jun 26, 2005

I'm not an ER nurse, but all of my patients get blood drawn on admission. We start the IV and connect a syringe to the catheter of the IV and draw blood, remove the syringe of blood and connect the IV tubing to the catheter. No need for 2 sticks usually unless the blood won't come but the IV site is good.

We do it the exact same way. It is kind of a pain because you have to keep one hand pushing on the vein while you screw in the syringe one handed into an unanchored IV, then you have to draw the blood, pull the torniquet, and then once again push on the vein while you unscrew the syringe and quickly try to hook up the IV tubing. I can do it without making a mess about half the time, I have learned to just put a towel under their arm so I don't have to bother with messy sheets--or my pants.

Aneroo, LPN · Jun 26, 2005

We draw blood (whether it's ordered yet or not- full rainbow) whenever we start an IV. If they only need blood drawn, we try to saline lock them to keep from sticking more than once. We have a vacutainer that connects onto the luer-lock saline lock we put onto the IV- makes it much easier. As soon as it's connected, all you have to do it make sure you don't pull the line out until it's taped. Sometimes we do have to restick to get blood. The IV is good, but the vein is too small to get blood off of. We try to restick with a butterfly. -Andrea

purplemania, BSN, RN · Jun 26, 2005

As a pedi nurse I did not want to stick my patient more than once, and drew blood from the IV site when it was initiated (but never again). I used 22 & 24 gauge cathethers too. However, I would not recommend doing this if more than 3-5 cc of blood is required as you could loose your IV site. Another trick is to put Emla cream on a secondary site. If you need more blood within an hour or so you can stick there with minimal discomfort. I have placed cream on kids when they were sleeping and I made 0400 rounds then returned for a.m. blood draws without ever waking them up. Of course with peds you often are able to use the microtubes that need only 0.5-1 cc.

mommatrauma, RN · Jun 26, 2005

If my patient needs an IV, I draw blood, if they need blood drawn, they are getting an IV...2 reasons...it's usually nicer for the patient..sometimes, you can't help but have to stick them more than once...2nd reason time management...if I'm in there, I get it done, one less thing I have to do it later...especially because Murphy's Law applies...if they tell you to draw blood but you don't need to put an IV in or vice versa...as soon as you walk out of the room it is inevitable that the same resident that said nah...don't bother, is chasing after you asking you to now do it...So its easier do it all at once...same with kids..especially kids...bloods and IV go hand in hand...When I do it however, just to give contrast on how others may do it...I put in the IV and hook the vacutainer or syringe directly to that to draw my blood, then I hook up my extension and flush it and tape it...simply because you tend to get less hemolysis of the specimens when not drawing through the extension...

nursejennie76 · Jun 26, 2005

We draw blood everytiem we start an IV just n case and to save the patient a stick. If the IV was hard ot get though and a small gauge we will do teh blood from another sight.

underwatergirl · Jun 26, 2005

Just a note to draw blood from an IV site you need an 18 gauge for the IV or you will break up the red blood cells...which matters for most lab test. I think it is always best to go with less sticks...however....

If you notice small viens or a hard stick and want to use a smaller gauge...20 gauge...then I say do it and then draw blood on the other arm...because if it appears difficult, you may have troulbe getting a vien and sticking them more than once.

Follow your policy and procedures and use your best judgement on individual basis. In the long run I actually prefer two sticks...one for the IV on for the blood draw...but hey that is my opinion and I rarely follow it, mostly do when I know I got alot of labs/tubes for blood draws coming out...don't want to loose the IV site....

Anyway hope this helps!

Annette

BETSRN · Jun 26, 2005

Hi, ER nurses-
Just a question for you....what does your hospital do if a patient needs an IV start and also needs blood drawn?
Do you initiate an IV and then draw blood from another vein? Or how does this work, exactly? How have you found works best?
I am not certain how to do this.
Thanks!
SRKnurse

I draw my bloods the same time I start the IV. Why stick someone twice?

Aneroo, LPN · Jun 27, 2005

Just a note to draw blood from an IV site you need an 18 gauge for the IV or you will break up the red blood cells...which matters for most lab test. I think it is always best to go with less sticks...however....
If you notice small viens or a hard stick and want to use a smaller gauge...20 gauge...then I say do it and then draw blood on the other arm...because if it appears difficult, you may have troulbe getting a vien and sticking them more than once.
Follow your policy and procedures and use your best judgement on individual basis. In the long run I actually prefer two sticks...one for the IV on for the blood draw...but hey that is my opinion and I rarely follow it, mostly do when I know I got alot of labs/tubes for blood draws coming out...don't want to loose the IV site....
Anyway hope this helps!
Annette

I use a 20 most of the time. I mean, our butterflies are 21 and 23 gauge!