Nurses can't draw blood, its always hemolyzed

Nurses General Nursing

Published

Okay, now that I've gotten your attention, I didn't really mean it...or did I =)

First and foremost I am not a nurse, I'm a technologist in the stat lab with a whopping 1 month of experience. Now, there's been some bad blood brewing recently between the lab and the ER. The issue, hemolyzed blood specimens. For the past 4 days, it seems as if EVERY single specimen sent from the ER is hemolyzed. We call because we need a restick, the ER gets ******, we get the tubes, its still hemolyzed, we get ******, we call again, they get more ******, we get the tubes, we get more ****** etc. etc. Its gotten to the point where the clerks won't even document a hemolyzed specimen and we have to speak to the Doctor directly. I'm just curious as to why all these specimens drawn from the lines are hemolyzed. Enlighten me.

P.S. Feel free to rant off about the lab and I'll try my best to shed some light upon your qualms.

Specializes in Emergency & Trauma/Adult ICU.
It can be ANY number of reasons. Here's a quick list of causes and corrective actions

http://www.bd.com/vacutainer/pdfs/techtalk/TechTalk_Jan2004_VS7167.pdf

Excellent resource - thanks! :)

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Specializes in Emergency Nursing.

Having been a phlebotomist and worked in the ER for a while now I am willing to bet $50 your getting hemolysed samples because many nurses who draw blood samples are using the IVs to get the samples instead of drawing the samples with a separate set up and as noted in the article that has a major chance of hemolysing the samples. In our ER we just have kids so in order to perserve atramatic care we don't stick them a second time for blood draws so we get all the blood we need before we even flush the newly inserted IV line. Sometimes the samples need to be redone but most of the time its ok. I think that if I was working with a relatively healthy adult I would just stick them again to get the sample rather than risk ruining the IV line to get a blood sample. But then again that's just me...

!Chris :specs:

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Specializes in med/surg 1 year, ER 5 years.

I've drawn blood after putting in an 18g needle and it's been reported back hemolyzed. I realize that sometimes it is the ERs fault that some specimens get hemolyzed but i have NEVER heard a lab tech admit that they made a mistake and I am POSITIVE that it happens sometimes. I think that a good portion of the blood that is reported "hemolyzed" was actually screwed up and it would be better for both the ER and the lab to admit fault when it's there so that there is less bad blood (pun intended) between us.

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cjcsoon2brn

That's exactly why the specimens are hemolyzing! They get the initial sample of blood during the IV insertion, then later when more test are ordered they go back into the IV site instead of poking the patient. The sample is most likely hemolyzied, they redraw the specimen and again it's hemolyzed, by the third time they're calling for the lab to come draw the blood stating the reason as the patient is a difficult draw and several people have tried.....well when I (lab) get there and I'm looking for a vein I notice the patient never has puncture marks?? and you've tried to get the blood several times?

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Specializes in Ante-Intra-Postpartum, Post Gyne.

Are the nurses drawing the blood when they start an I.V.? When I was in school I did some extra training at a different L&D than I work at now, they had recently stopped having the nurses draw blood when they started an I.V. stating it caused the blood to be hemolyzed...we do it at the L&D I work at now and the lab has never complained so I am not sure which hospital is correct.

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Remember that when extracting blood, do not "tap" the vein since it causes hemolysis even before drawing the blood. The specimen must be delivered immediately to the lab since it hemolyzes with time.

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Specializes in Trauma/Critical Care.

Hi Guys,

I am of the same agreement with my fellow nurses: Those ER nurses are drawing from an IV site, which is fine, but if a small bore needle is used, hemolyzation is more likely to occur. My advice would be, if the hospital has a policy that permit ER nurses to draw samples from a peripheral IV site...maybe educational inservices should be implemented in the ER. We have to remember: Patient's safety is always first.

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Well, let's think about this. Are there new staff in the ER? Different supplies? Or just all of a sudden, *for no reason* there has been a spike in hemolyzed specimens?

But I will ask you something. Why, when the lab calls and claims that certain specimens are hemolyzed, and I say "OK, it took 3-4 of us to get the blood that we sent you, and the pt. is X (known frequent flyer/brittle diabetic/renal failure/crap for veins)"

...

after a few seconds of silence, does the lab say "we'll see what we can do." And 20 minutes later, like manna from heaven, I have results from those specimens!

There are two seperate occasions when we can catch hemolysis. Once the specimen is taken out of the centrifuge we see that its hemolyzed, thus it won't be run, and we'll make the call for a restick. Or we miss it and it gets ran anyway, but the results come out funky where potassium is 6.9 after the patient had been running a 4.0, creatinine levels are all out of whack etc etc. When we see something like this, we go back to the instrument, recheck the racks and see whats wrong with the specimen. More often than not its hemolyzed or diluted (another problem caused by drawing from the line). So then thats when we make the call. Sometimes, results from a hemolyzed specimen will still correlate with what the patient has been running. In that case, we file it, why restick the patient? When the lab calls about hemolyzed specimens and they call fairly quick, that means they caught the hemolysis after spinning it down. If it took some time for them to call, they probably have results but just aren't willing to file it because they caught the hemolysis after the fact. Thats why when we call and you sweet talk us a little bit, bribe us with a late night rendezvous in the morgue, your results magically appear like manna from heaven.

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Specializes in jack of all trades.

We draw our own labs in dialysis and what I found was they werent rotating the tubes gently after the draws and just setting them down also or shaking them too severely. The tubes would sit for a few while they did something else and would be hemolyzed. Therefore if any preservative or anticoagulant they werent mixed well causing hemolyzed specimens. Except our tiger tops they always sit for 30min then we spin. Everything else straight in the fridge never sitting down. Just a thought.

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Specializes in Trauma/Critical Care.
cjcsoon2brn

That's exactly why the specimens are hemolyzing! They get the initial sample of blood during the IV insertion, then later when more test are ordered they go back into the IV site instead of poking the patient. The sample is most likely hemolyzied, they redraw the specimen and again it's hemolyzed, by the third time they're calling for the lab to come draw the blood stating the reason as the patient is a difficult draw and several people have tried.....well when I (lab) get there and I'm looking for a vein I notice the patient never has puncture marks?? and you've tried to get the blood several times?

I understand your irritation...for some reason other floors believe that ICU nurses are great at starting IV's (which makes you wonder, since almost everyone in ICU has a central line or PICC:imbar). There is nothing more irritating to me that to be called to assist with a "hard stick"...you get there and notice that the patient doesn't have any punture sites...:angryfire

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Specializes in ER/EHR Trainer.

Do you work at my facility? All samples are hemolyzed....20+ nurses daily drawing incorrectly? Don't think so....

We all use 20 g and above iv caths when drawn....I don't even use the tourniquet unless necessary. HOWEVER it really shouldn't matter....babies 24 g needles, ports and piccs-drawn.....and butterfly 25 g....so.....is it the new system between BD and Baxter(2 years old)? God forbid we should buy it from the same company

Is it the tube vac system shaking them up?

Is it the lab leaving them laying around for 1-2 hours....ooooh that might be it! At least if you work in my facility....

Anyway...the ER doesn't do anything special to hemolyze samples....in my own investigation it comes down to receiving or in our case accessioning....now I call and tell them all of mine are stat....guess what? Rarely a hemolyzed sample...

Hmmmmm........

I don't know about all of you, but I want my iv and blood done at the same time...One stick...and so do the patients!

Maisy

PS drawing through the line is a big no no with me...but our phlebotomists have been known to do it!:D

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Personally as a nurse I will only say that I hate drawing blood. It is the one thing in nursing that I absolutely hate doing. If I had wanted to draw blood I would have gone to school to be a lab tech. Unfortunately since I went to school this task has increasingly fallen on nurses. Anytime I look for a new job I am careful to find out if the job includes drawing blood. Even starting IV's doesn't bother me. It is just something about fussing around with the little tubes while hold still and keeping the patient still- yuck! The worst stress.

Still, no one has ever said my blood was hemolyzed that I recall. Though in home care it is either a venipuncture or a central line that we draw through. Useless butterflies always seem to clot off before the blood is done.

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