No blood draw from IV starts?

[Larry77]

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.

[BBFRN, BSN, PhD]

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]

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]

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]

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]

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.

[Spidey's mom, ADN, BSN, RN]

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

But, until the poster clarifies . . . .

steph

[PedsER-RN, BSN, RN]

working in a pedi er, i draw my blood from the iv if possible, and i put my iv's wherever i can get it on the 1st stick. if an iv won't draw, then i'll do a butterfly on the ac of the opposite arm or a heelstick if it's a newborn. i don't have too many that come back hemolyzed; if they are, sometimes the lab results it anyway depending on the acuity of the pt. and the docs take that into consideration.

[longjourneydream]

I'm guessing it was peripheral "line" . . .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

We used to get hemolysis problems from both IV and direct blood draws, it made no difference on the experience of the tech or nurse, sometimes it was the circumstances behind the draws.

EX:

1. Bad tubing ( we have many duds).

2. Where you are drawing from and what type of vein.

3. If you force blood out with syringe may damage RBC's.

I have been only drawing for a couple of years, but have never had one sample come back hemolized (maybe its just luck).

I draw from IV's only after I put it in and never force (some will give blood, others will only recieve;if it will only receive, that is fine with me, I will leave it alone.

I never draw from an IV that has been receiving fluids already; because I have seen many distroyed in this manner.

There are so many variables so I really don't know the factors that cause bad blood samples, I am only going from experience, and things I have seen on the floor as a tech.

As an RN I will never draw from a perfectly good running IV, only from a fresh IV stick that is in a good juicy vein...

[UM Review RN, ASN, RN]

I always draw labs from our direct admits from the new IV access to minimize sticks. Never had a problem, plus I get bonus points from the patient/family when I tell them what I'm doing and why.

[iluvivt, BSN, RN]

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!!!!!! of course you can draw blood from a peripheral site. I an a CRNI and know the standards vey well. you are confused!!!!!!

[jojotoo, RN]

In my ER, on day shift, the RN starts the IV or HL and then calls lab for the blood draw. On night shift, the RN starts the IV or HL and draws blood at the same time. This is departmental policy. We have about equal number of hemolyzed specimens on each shift.

[DebanamRN, MSN, RN]

In the ER where I work, we insert the canula and draw from that directly. I don't attach the loop until the blood is drawn. Of course, having the right equipment available helps. I have had a couple of labs come back hemolyzed, but this was hours after the draw and I think the lab "lost" the blood for a while.

Honestly, if we couldn't draw at the time of insertion, it would cause a lot of trouble, as most of out pts are over 80 years old, have multiple co-morbidities and their veins were shot years ago. If we can get a good vein, we need to take advantage of it.