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Discussion

Strange request from a resident

I've been a nurse for a long time...all of it in teaching hospitals. As such, I've experienced years of working with new residents. One of our current residents has a strange request I've never seen before. He asks that CBC draws be done from a peripheral stick instead of obtaining them from central lines.

When I questioned him as to the rationale behind his request, he said that the CBC from a central line will be "dilute". I pointed out that the Q 8 hour chem 7 order has been drawn from the same central line for 2 days now, and he said that a CBC is more likely to be dilute than a chem 7.

I'm assuming that he had a bad experience with an inaccurate draw at some point during medical school or prior this year, and perhaps a patient had a bad outcome. I otherwise respect this resident, and think he will make a great doctor. I'm hoping to talk about this more with him over the next few weeks, but before I do, I was wondering if anyone has heard this before, or maybe has some insight into this topic. Thanks in advance!

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    He probably does not know, yet, what he does not know.......

    Yes any blood drawn from central lines,, may be delute if not prudently done, as not drawing. Adequate wasting....

    However, Us Seasoned nurses know that...

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    • Author
    He probably does not know, yet, what he does not know.......

    Yes any blood drawn from central lines,, may be delute if not prudently done, as not drawing. Adequate wasting....

    However, Us Seasoned nurses know that...

    That's what I'm thinking too Sally. Thanks :)

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    I think I would bring it up in a casual way such as, "Sounds like you had a bad experience in the past with blood not being drawn properly huh? I make sure I waste such and such amount per policy...(depending on type of system.)

    If he doesn't take kindly to reassurance from you, eh. What can you do. You tried to educate at least.

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    Assuming adequate waste....

    That makes no sense...Either the line has IV fluid in it or it doesn't. There's nothing about a purple tube that will magically find IV fluid and dilute itself, while a green tube would stay free of that same IV fluid.

    That dilute sample was drawn incorrectly. If one doesn't waste adequate blood, the sample will be dilute regardless of which labs are drawn.

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    And if I was the patient with a central line being pokeD Q8 because the resident said so... Mmm mmm. I ain't doin' it.

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    Our patient population doesn't have the best veins either.

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    Our patient population doesn't have the best veins either.

    Which is probably why they have the central line. Oy. I'd have to have a little chat with this resident. Or his attending.

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    Our patient population doesn't have the best veins either.

    I was just about to say (was thinking it as reading the posts) there is probably a reason for the labs being drawn from the central line- in most cases it is because there is pretty much no peripheral access...

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