Use of a tourniquet on a geriatric patient to draw blood

[mrsreid0520]

I currently work at a independent living facility for seniors. We have a doctor makes house calls to the residents in their apartments. When he needs blood drawn from the residents, he has his medical assistants draw the blood. I have witnessed quite a few blood draws and I noticed that his medical assistants leave the tourniquet on until after they are done filling up the vials. Is this because of the decreased circulation? When I went through school I was taught to pop the tourniquet after I established blood flow. And when his medical assistants start drawing the blood, I can clearly see that they established blood flow. Is the use of a tourniquet different on a geriatric patient? Please help!! Ive tried researching it, but my search has came up empty!!

[amoLucia]

This inquiring mind kept thinking about your question. I have no official scientific rationale for this, but to my thinking, I don't see a difference for 'geratric' populations. But thinking about vasculature, arterial flow is AWAY FROM the heart with higher pressure, while venous flow is TO/TOWARD the heart with a lower passive pressure. A tourniquet should just be tight enough to cut off venous return. In essence, blood kind of seems to 'puddle' there. If you pop the tourniquet, you've re-stablished unobstructed venous flow and released the 'puddle'. So maybe that's a little advantage to keeping the tourniquet on until the tubes have been pulled off (even after blood flow has 'flashed').

In general, geriatric pts might be more difficult as their veins may be sclerotic and there could be just enough of a miniscule dehydration that leaves them a little 'dry' for the labwork. And then there's the pt who'll tell you "I'm a hard stick.

I think I'll check with a lab tech next chance I get.

[AlexCNA]

I've never been a lab tech or LPN, but I follow our lab techs when they are doing their draws because we have a lot of people that fight them and have noticed that they always pop the tourniquet after they get a flash. These particular people only draw from LTC facilities so I would tend to think they were doing it correctly.

[Asystole RN]

Poor practice. The best practice is to not use a tourniquet at all. Now that being said, it is much easier to keep the tourniquet on rather than have to place it back on after a stick.

[AlexCNA]

I spoke to a lab tech I know about this and she said she immediately pops the tournequet unless she has more than 3 vials. In that case she waits until she is almost done with the last vial to pop it in order to maintain pressure.