Popping off top from lab tube when drawing labs

[pattykolo888]

I am brand new to nursing. I am working at a hospital that utilizes an IV team. I was taking care of a patient that was on a heparin gtt that needed a PTT lab drawn. She was a hard stick so we had IV team come and draw from the line. I was watching the IV RN use a 3 ml syringe to draw back blood from the line, popped off the top of the lab tube and then proceeded to squirt in the blood. Is this acceptable? Have other nurses seen or do this as well? To me, it just seems like the results may be skewed.

[WKShadowNP, DNP, APRN]

If there was not a way to transfer the blood into the tube safely, it is acceptable, provided that an adequate amount (not too much) pressure is applied, which prevents lysis of the blood cells.

We do prefer to use a safety transfer device to prevent contamination or destruction of the sample.

[NurseGirl525, ASN, RN]

We were told by the lab to never pop the lids off. It contaminates the sample. Plus, it does not seal back on properly causing quite the mess in the tube system. It costs upwards of $30k to clean it.

Never pop them off.

[pattykolo888]

when you say "safety transfer device" do you mean a vacutainer?

[WKShadowNP, DNP, APRN]

when you say "safety transfer device" do you mean a vacutainer?

That is but one brand of them. Greiner is another. But basically the ones with which I am familiar have a clear barrel that a needle is screwed into. One has a rubber stopper (and this is the side the tube is pierced by) and the other is a luer-lock for syringe methods or the butterfly; also there is one with the needle that goes into the vein and the other end is the rubber covered one in a clear barrel.

[blondy2061h, MSN, RN]

I always just put a needle on the end of the syringe and put it in the tube that way. That's also wrong, because you risk sticking yourself. Do it the way Shadow says.

[NurseGirl525, ASN, RN]

I always just put a needle on the end of the syringe and put it in the tube that way. That's also wrong, because you risk sticking yourself. Do it the way Shadow says.

I just use a blunt usually, therefore no stick issues. I'm just confused as to why anybody would pop off the top. Especially for 3mL. I heard people do it to try and completely fill the tube. That's not what's happening for 3mL. To me, breaking that seal risks too much. Especially with a tube that you put anticoags into.

[A&OxNone, MSN, RN]

In peds, we do this all the time because the little veins can't handle the pressure of the tube suction. So we draw blood with 3 ml syringes and do one of three things - do exactly what she did and take the top off, take a needles and poke the top (which like somebody else says, risks you sticking yourself), or put it in the tiny pedi tubes that require the tops to be taken off anyways. As far as the blue tops, taking the tube off wont really skew the results as long as the right ratio of blood is used (which thats the only one that matters, anyways). Hope that helps.

[Wuzzie]

It isn't the best way but sometimes you've gotta do what you've gotta do. On pedi patients and billion year old ladies I have sometimes popped the top off a blue tube and let the butterfly tubing literally back drip into it when I couldn't get it to draw with a syringe. It works. It's slow but in a pinch it does work. There is a special tape (I forget what it's called)that you can secure the lids back on with. And of course these should be hand carried to the lab and the staff notified that the vacuum has been breached so they don't have an exposure incident. I only advocate this as an absolutely last resort and I'm sure someone will come along soon and tell me I'm The. Worst. Nurse. Ever!

[canoehead, BSN, RN]

I've popped the top off and let the blood drip from an IV site that I couldn't draw back from. Got enough for very basic labs, and its better than nothing.

[mrsboots87]

If the blood was in a syringe, I just don't get why they would have risked contaminating the sample or having the top fall off when sent or brought to lab.

When i draw from central lines, I either use the adapters that allow the line be connected right to the piece that punctures the lab tube, or I withdraw with a 10ml syringe and then use an 18G or larger needle to transfer the blood to the tube by puncturing. Using a needle increases risk if needle stick, but at least the sample is left uncontaminated.

[mrsboots87]

I've popped the top off and let the blood drip from an IV site that I couldn't draw back from. Got enough for very basic labs, and its better than nothing.

I was always told we can't draw from an IV site as they usually hemolyze the sample. Is there a time or instance when this is ok? (New nurse with 10 months experience only who is truly curious.)

My charge had me do it once to show me. When spinning the blood in a tiger top gel tube, the blood cells didn't fully separate from the serum like it should have because they hemolyzed when coming through the IV cannula. The serum was pinkish instead of the normal yellowish color.