Serial blood draws

[kitten9199, ADN]

I am a nurse that does growth hormone testing on children and adults. We use a regular angiocath that we insert to draw baseline labs and then give medication over 30 minutes and continue to draw blood from the line every 30 minutes until the 150 minute mark. I am having trouble getting blood back through the catheter after giving the infusion. The IV flushes without a problem, the fluids are opening the catheter, but it seems to be collapsing when pulling back. I can't seem to find a catheter out there that will work. Therefore we end up doing venipunctures every 30 minutes in order to finish the test. That is fine on an adult but sometimes these children are 2 years old. Does anyone know of a catheter made for serial blood draws? The IV would only be in for approximently 3 hours total.

[iluvivt, BSN, RN]

Let me see if I can give you some ideas so you can make this more successful. First the problem is not the product you are using and there is no special catheter that will solve your issue. Generally speaking, PIVs should not be used for routine blood draws after they are inserted. It is a common and acceptable practice to insert a PIV and draw blood for sampling and then initiating an infusion. In the scenario you described it can be done but as you has found it is often not successful. There are several things you can do to INCREASE your success so you can keep the venipunctures to a minimum.

1. First look for a very full soft vein.actually feel the vein to make sure it is. The larger the vein the better so odds of obtaining blood samples is increased. The goal here is to select a good large vein and put a smaller size catheter in it so you still get good blood flow around the catheter. That way when you attach your syringe and pull back on it to get the blood sample the vein will not collapse.

2. Select a smaller size catheter..in the adult you can use a 22 gauge or if the vein is very large you can use a 20 gauge. In the children a 24 or 22 gauge can be used depending upon the vein size and location of the vein.

3 Avoid the ACF if you can BUT you can get the benefit of the great blood flow in this area by feeling the veins in that area and trace it down and access the vein below the ACF. You are then avoiding the areas of flexion and promoting vein preservation. Another thing used to do in a similar situation that that used to happen with our nuero pts is to place a PIV at or near the ACF for blood draws ONLY..lock it off..then start another IV for the prescribed IV therapy. So I started 2 IVs and put one in each arm so it would be easier overall. The short time of this infusion allows me to suggest this an option. This would not be the best option if the pt as going to be hospitalized

4. Here are some things you can do to optimize obtaining the sample..you should also be doing a discard before you get a serial sample if you are using the same PIV...use gravity..hang the limb in a dependent position...its OK to apply a tourniquet..but have your equipment ready so you do not inadvertently clot off the line...DO NOT use a vacutainer unless you have a very large and full vein...rather use a syringe....a small size syringe will not cause as much negative pressure and collapse the vein wall...so have some ready...you can try with a 10 or 6..but if hat is not working try the 3...do not pull hard...slow and steady works much better

and your specimen will not be hemolyze.

5 How old is the youngest child you have? Children can be challenging. I would definitely use a warm pack or warm blankest on the children . You can even leave a nice warm blanket on during the infusion...but do not obstruct the view of the site for monitoring.

Careful planning ,a good site selection and appropriate catheter gauge selection will increase your odds...

[kitten9199, ADN]

Thanks iluvivt.