Sickle cell crisis labs

[JessieSokol-Yu]

I've had two sets of labs rejected this morning on one of my SCC pts. She has a midline in and it draws beautifully. However, I would get calls that they were "grossly hemolyzed". I'm wondering if that's just a normal problem with these types of pts or if maybe I'm not drawing the lab properly. If maybe lab should run the tests ASAP or what?

[psu_213, BSN, RN]

We are, by policy, not allowed to drawn labs through a midline. Someone more familiar with the physical properties of midlines may be able to tell you if/why midline sample are more likely to be hemolyzed compared with PICC sample. If they were "grossly hemolyzed," I doubt that lab running the sample ASAP would have helped.

[iluvivt, BSN, RN]

It more likely was more to do with your technique in this case. Yes you can draw blood from a midline catheter.Though I generally discourage the practice. This is because it tends to decrease the dwell time of the line.This is in part due to the increase in thrombotic occlusion when the line is used for frequent blood draws. I prefer nurses to think of it as the line needed to administer the prescribed IV therapies as long as they fall within the acceptable phone and osmolality guidelines. Now for the blood draw...if you draw it too quickly or if you are having problems with the draw and are really pulling hard on that syringe...you will create too much turbulance and the cells can break. That midline tip is in the upper third of the arm .near the shoulder just before it takes the turn into the Axillary vein, so you will usually be getting a good brisk blood return. You need to draw slow and steady and if you fell the syringe vibrate you are pulling it too fast. IF you are drawing directly through a vacutainer and it drawing too quickly...you may need to do some things to slow it down..such as arm elevation.lose the tourniquet if you are using one ( you really do not not need one for a ML draw) or switch to a syringe.or switch to a larger syringe ( I like the ten ml ones). So too fast.too slow.or even prolonged transfer times can hemolyze your speciman. Have more than one option to do the draw when you go to the bedside and all your supplies so you can change your method if need be. SLOW AND STEADY..TRANSFER AS SOON AS YOU CAN AND LET THE THE PRESSURE EQUALIZE IN THE TUBE.Do not push the blood in.This will so minimize blood exposure unless you have a hemogard type tube.

[iluvivt, BSN, RN]

That is ph ...my silly phone changed it for me