IV starts and drawing blood

[srknurse]

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

[mguillen]

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.

Your explanation is so wonderful! I just have one question: how do you connect the vacutainer to the tubing?

I need to draw blood on HIV patients and then provide them w/ immuno IV therapy, so I'm concerned about my safety and about their comfort. Thank you!

[TRAMA1RN]

Believe it or not, you can actually start an IV as small as a 24 gauge and use a device from Kendall tyco/healthcare called an Angel Wing attached to your extension set to draw blood. DO NOT FLUSH YOUR EXTENSION set first and draw only your essential tubes, tubes DO NOT NEED TO BE COMPLETELY FULL. YES, you can draw from a 24 gauge IV catheter I have done it very successfully 100% of the time. I draw all my patients this way. Not all my patients are 24 gauge IV sticks by any means most are indeed 18 gauge and 20 gauge sticks but I do use 24 at times for very sick babies, and do draw my labs on them this way if needed, if I don't go IO. Angel Wings are the way to go instead of with a syringe, the pressure created from a syringe is what causes the hemolysis of the RBC's.

[cjcsoon2bnp, MSN, RN, NP]

I work on an adult med/surg floor and while the nurses do start IVs fairly regularly in general we don't get blood from the IV unless the person is a hard stick. While we like to avoid any extra sticks we don't want to have to redraw a patient if the sample from the IV was bad or risk ruining the IV site because of a blood draw. On the rare occasion we will use an IV insertion to get blood from the nurse will hook up a syringe to the short extension tube that connects to the catheter and draw into the syringe and then they will flush and cap until the site is needed.

!Chris

[nuangel1, BSN, RN]

we draw from ivs on insertion all the time no problem in our ed .we use 18-20 mostly some 22 .we also have butterflies .cultures require 2 sticks.we do have a few redraws but mostly no problems.

[Christy1019, ASN, RN]

In my DEM its pretty standard practice to go ahead and start an iv on the majority of pts (unless they are there for chronic back pain x 10 yrs and they decided to just now come in for it lol), after threading the catheter into the vein and the needle's taken out we apply pressure where the cath tip would be and connect a vacutainer directly to the hub of the iv, draw a rainbow, then apply pressure again, remove the vacutainer and connect the saline lock, flush and then pop a tegaderm on and tape it down. a lot of us have found that drawing the blood from the tubing after connecting the saline lock results in our potassiums coming back hemolyzed more than 50% of the time.

[Guest343211]

To the nurse that says 18G. . .nah. You can infuse blood through a 20. On an adult, it is more ideal to have an 18G, but it isn't always possible. If you can influse blood through a 20, you can certainly obtain labs.

Overall it's a finese kind of thing--drawing carefully to prevent hemolysis and inserting the IV and drawing blood without making too much of a mess.

In kids--shoot on newborns, you get a lot of labs by way of heal stick. Talk about finese. On some kids it's a pain in the butt--and for those, I'd rather have a nice vein or artery to draw from.

[Guest343211]

BTW, you would be surprised at how some local yocal community ED's won't streamline the process and insert IV and draw labs. This is one reason--among many--why I prefer working in a lot of city or university hospitals as opposed to some community hospitals. One local yocal ED would only let their IV team insert IVs--meanwhile the kid was so dehydrated, I thought she was going to exanguinate right then and there. It would be very frustrating for me to work in such a "mother may I" environment.

[Guest343211]

Nuangle,I totally agree.

[joeb1, ASN, BSN, RN]

I work in a Pediatric ER where I start 5-10 babies/toddlers every shift, and our docs always want blood drawn with starts. The way we found to not hemolyze or affect our samples, and keep in mind we usually only draw cbc/bmp/crp/cultures, is to start an IV, no matter what size, put pressure on the vein, and place the tube directly under the catheter hub, allowing the sample to drip carefully into the tube. Then we get the culture by using a sterile syringe for that small amount of blood. A benefit is the vein bleeds at its own rate, and I find they stay patent much more often than when using vacutainers or syringing out all the blood. It coud make it messy if you don't have everything ready, but I've gotten used to it this way. ANd lab has never had a problem with this.

[Pat_Pat RN]

I almost always start my cath, pull the needle and connect a 7"? (we call it a pig tail) with an empty 12mL syringe via a PRN adaptor. I then draw blood via the syringe, slowly. Filling the 12mL syringe gives us plenty of blood for a green, purple and blue top tube. If it is someone who I think will need blood cultures, maybe T&S or a lactic acid, I just take the first syringe off and put on another one. Then I attach a flush syringe and flush it. Tape the works down and you are good to go. You have only made 1 possibly dirty connection, the pigtail to the cannula.

That is why I like this method, not nearly the possibility of infection from sticking the vacutainer collector in the cannula hub, taking it out and reconnecting the IV tubing.

We have vacutainer guards with a luer lock connector to screw to the syringes.

I think lots of the hemolysis occurs from the speed of the "suck" from the vacutainers. When you can feel cavitations....it is going too fast!

[Lunah, MSN, RN]

Our lactic acid lab draw protocol dictates that we draw that tube first, and without a tourniquet. Let me tell you, that is sometimes a VERY difficult draw!