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No blood draw from IV starts?

Posted

Specializes in Trauma/ED. Has 10 years experience.

One of the facilities I work agency in just recently "banned" blood draws from IV starts unless they are a code/trauma/child or limited sites d/t fistula etc...is anyone else doing this?

Their rational is the supposed high rate of hemolysis from these draws and it was slowing down lab times because the lab wasn't calling the nurses to let them know the sample was hemolyzed. I had never heard of this kind of policy before (except from PICC lines) and think it is rather stupid causing the patients an extra stick just because some nurses possibly need some education on ways to minimize hemolysis when drawing from an IV start.

One of the facilities I work agency in just recently "banned" blood draws from IV starts unless they are a code/trauma/child or limited sites d/t fistula etc...is anyone else doing this?

There rational is the supposed high rate of hemolysis from these draws and it was slowing down lab times because the lab wasn't calling the nurses to let them know the sample was hemolyzed. I had never heard of this kind of policy before (except from PICC lines) and think it is rather stupid causing the patients an extra stick just because some nurses possibly need some education on was to minimize hemolysis when drawing from an IV start.

We do not have a policy like this -- I'm actually on orientation and am thrilled with the concept (obviously I'm an ER newbie as it seems this is a common practice and I'm just now getting excited about it.. LOL). But I did ask the question (about hemolysis) and they said they've done studies at the hospital within the lab and haven't had that issue enough to blame it on drawing via IV start.

I figure what's the difference between drawing blood with a butterfly and drawing blood with a 18g attached to a J-loop? I'd expect the butterfly to hemolyze before the other.

CritterLover, BSN, RN

Specializes in ER, ICU, Infusion, peds, informatics. Has 22 years experience.

one of the facilities i work agency in just recently "banned" blood draws from iv starts unless they are a code/trauma/child or limited sites d/t fistula etc...is anyone else doing this?

there rational is the supposed high rate of hemolysis from these draws and it was slowing down lab times because the lab wasn't calling the nurses to let them know the sample was hemolyzed. i had never heard of this kind of policy before (except from picc lines) and think it is rather stupid causing the patients an extra stick just because some nurses possibly need some education on was to minimize hemolysis when drawing from an iv start.

the ed where i work has tried to institute this policy, and it frustrates me, too.

i highlighted the part of your post that i feel gets missed by everyone that tries to implement this rule.

i think sometimes nurses try so desperatly hard to get blood from that iv start, that they sometimes "force" the issue, causing the hemolyisis.

there are ways to minimize hemolysis. i think that needs to be emphasized. (sometimes i think that a poster presentation, put up in the med room, might be a good idea.

i work in triage quite a bit, and we tend to start most of our ivs/draw most of our blood there. i pay attention to which patients come back with hemolyzed labs, and i have learned how to minimize it.

while i know that everyone outside of the ed hates ac ivs, getting blood from the iv start that isn't hemolyzed is one of the reasons i tend to put my ivs in the ac. (unless i just know the patient is going to be admitted right away. in those cases, i will try -- gently -- to get blood from an iv site in a different area. if the blood doesn't come easily, then i'll do a separate stick).

i just wish that management would try to trouble-shoot the problem, and provide education to minimize it, before they out-right try to ban the practice.

you know, it is just one more example as to how the unfortunate emphasis on ed los is negativly impacting patient care.

JBudd, MSN

Specializes in Trauma, Teaching. Has 40 years experience.

There was an article about research showing greater rates of hemolyzed tubes in JEN last year. It was only one study, and frankly the rates weren't that high. THe authors said more studies needed to be done as well.

Sometimes folks will read one article and try to formulate huge policy changes without doing the full research. They are so eager to be cutting edge and up to date on the latest news they don't think it all the way through.

What are the numbers in your facility regarding hemolyzed tubes? If they really are that high, this is a quick fix that doesn't really address the problem of poor technique.

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

Drawing blood thru a peripheral vein is not recommended by the Infusion Nurse Society's standards. And remember, even if you are not familiar with the standards, lawyers are.

Drawing blood thru a peripheral vein is not recommended by the Infusion Nurse Society's standards. And remember, even if you are not familiar with the standards, lawyers are.

well, i dont think i am going to try the jugular or other large vein.....however if you meant peripheral venous access, i would see you point

Anagray, BSN

Specializes in ER,med-surg, LTC, psych, dialysis. Has 17 years experience.

I met someone recently who works for the state lab QI division and I have asked him many questions regarding the bloodwork problems. He believes that most problems with hemolysis occur due to tube types and problems inside the needle itself. At work i sterted uding yellow top tubes vs the red and i have encountered far less hemolysis problems with IV draws.

Nat

I can't remember the last lab that came back hemolyzed.

We draw blood with the IV start in ER and OB.

I agree - more education is in order instead of stopping a procedure that can work well.

steph

ERRNTraveler, RN

Specializes in Peds, ER/Trauma.

Drawing blood thru a peripheral vein is not recommended by the Infusion Nurse Society's standards. And remember, even if you are not familiar with the standards, lawyers are.

If you're not drawing blood from peripheral veins, then WHERE are you drawing it from??? :uhoh3:

If you're not drawing blood from peripheral veins, then WHERE are you drawing it from??? :uhoh3:

I'm guessing it was peripheral "line" :confused:. . .which is not what we are talking about here anyway. After an IV is established, it is difficult to get a good blood sample. I have lab come out of the pts room and ask me all the time if I can stop a running IV for awhile and get some blood.

But getting blood from an IV start is different.

steph

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

Drawing blood thru a peripheral vein is not recommended by the Infusion Nurse Society's standards.

Can you explain this?

Did you mean to say that the INS does not recommend blood draws from existing saline locks or something like that? Because the way your post reads, it seems that you're suggesting either arterial sticks or sticks on central (not peripheral) veins (interior jugular, femoral, subclavian, etc.), and I'm pretty sure you don't mean that ...

Do you have more info on INS standards on this topic that you can share with us?

Kidrn911

Specializes in Peds ED, Peds Stem Cell Transplant, Peds. Has 12 years experience.

If you're not drawing blood from peripheral veins, then WHERE are you drawing it from??? :uhoh3:

That is what my thought was:trout:

BBFRN, BSN, PhD

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research. Has 15 years experience.

I've never had a hemolysis problem drawing blood from a fresh IV. One study vs. thousands of nurses stating the opposite doesn't constitute good evidence based practice, IMO. Maybe you and your coworkers could get your own study going on this.

wizap

Specializes in ER, OB, Med/Surg,. Has 14 years experience.

I will routinely draw blood off my Chest Pain patients who have big bore IV's, and have done this for years. The ER doc's know we do this. However, I will not draw from a 24g. in a toddler. I don't want to loose my site!

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

Drawing blood thru a peripheral vein is not recommended by the Infusion Nurse Society's standards. And remember, even if you are not familiar with the standards, lawyers are.

What do they call the veins the phlebotemist uses, if not peripheral?

I saw the OP's issue as more about the lab not notifying when the patient needs a restick. As far as drawing from the line is concerned the patient is no worse off even if the blood hemolyzes, but it is a huge inconvienence for the facility. Whose needs are we putting first?

rjflyn, ASN, RN

Specializes in Emergency. Has 23 years experience.

And then there are days I wonder what the lab is doing to our blood. One day you have nothing hemolyze and the next every other pt you draw on has to be redrawn.

By the way an external jugular line is a peripheral IV, so I don't know where they want me to get blood if its not peripheral because last I checked I cant start a central line.

Rj

TRAMA1RN

Specializes in ER. Has 15 years experience.

The way to fix this problem is to call lab for each and every blood draw they will then change their tune, I know this for a fact. Been there done that.

I really think the poster mean a peripheral IV . . . not a blood vessel.

But, until the poster clarifies . . . .

steph

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