Tricks for drawing blood?

[amzyRN]

The place I'm going to be working at doesn't have a phlebotomist, I'm wondering if anyone has any mnemonics for the ordering of tubes? I know you're supposed to draw the blood cultures first, then the blue top and green before the other tubes. I know this is kinda a silly question, I apologize.

Both the ERs I worked at before had phlebotomy (which I actually liked) because of the overload of patients they thought it would help us out and it did. Some people have such strong flow with a tourniquet on it's hard to contain it with pressure applied. I hate making a big mess.

[PeakRN]

The order of tubes aren't really as important as people think, and other than cultures first (as the open tops of vacutainers are not sterile) and make sure volume dependent tubes are full (ex: sodium citrate tubes). With the exception of sodium fluoride and sodium citrate tubes the anti-clotting or clot-activating agents are dried to the side of the tubes and require a significant amount of mixing before thoroughly introduced in the sample, and compared to potentially not getting the sample you needed most but was drawn last there is little importance of order in the ED.

As far as being hard to contain, do you mean applying pressure after withdrawing a butterfly or straight needle? You certainly can (and should) remove the tourniquet before withdrawing the needle. You can also punture a vein without a tourniquet if you are concerned with the vein blowing. If you mean having difficulty with tamponade when placing a angio, you can use more than one finger in a row if you are having difficulty approximating where the angio tip is in the vein.

[Scrub_in_scrubs]

I laminated the order of tubes and put it on the back of my ID badge. It's always close by that way.

[JKL33]

You'll probably be able to get a better idea of minimizing the mess once you see the exact products they work with.

For a simple draw (without IV start) you could use winged collection set with vacutainer transfer device attached at the end; plug in the tubes sequentially and let them fiill and you're done. (I've seen people lightly apply a piece of paper tape over the wings during the collection process as it makes them feel like they can then have two hands free while collecting the tubes.) Remove tourniquet and apply folded 4x4 @ the site, remove needle (you can do this and activate the safety shield in one smooth movement).

When starting IVs I've seen people simply attach the unprimed catheter set and draw through that into syringes, then use the transfer device to transfer blood to tubes. Or you can attach syringe(s) or access/transfer device directly to cannula, draw all the blood and then remove the tourniquet and change out the access/transfer device (or syringe, if that was your method) for the catheter set. When attaching anything directly to your IV cannula, in order to avoid the mess as often as possible you do need to remove the tourniquet first and then approximate the length of the IV catheter and apply quite firm pressure at the point proximal to the insertion site that represents the end of the catheter.

Know your facility's policy for special tubes. For example you'll be drawing a fair amount of LAs which some places insist be drawn without a tourniquet (despite this practice being of questionable value) and put on ice depending on the testing methods/instruments at your facility.

Get all your items prepared before you start so you can quickly grab things in the order you'll need them. It takes a little planning and dexterity at first but you already know the basic principles of everything you'll need to do so there's not a lot of new learning.

[amzyRN]

Thanks for the tips! The unprimed catheter set is a cool trick I'm going to tr it. I've always just pulled blood off in syringes and transferred them to tubes after making a huge mess because I left the turniquet and tried to stop the flow with manual pressure.