drawing blood off iv?

I had a pt last nite and the day shift nurse said that she had been drawing blood off an existing iv, so I did the same. Is this a no-no?

What kind of I.V.? Any additives in it?

'Cat'

Like Cougar said....depends if it has running fuids, or adds. But the act of drawing off the IV is fine as long as it does not alter your lab values....careful, you don't want to ruin your ony working IV if it clots/collapses by drawing off it...

no just a great 18 g iv with no fluids going:etc

cougarnurse wrote:What kind of I.V.? Any additives in it?

'Cat'

I'd use it.

do you have a procedure for drawing off an existing line? Did you just draw from a HL or SL or did you discard anything before sending the lab?

If you're drawing off an IV lock you just want to be sure to keep it working. I'd discard about 5ml before getting the lab specimen, then be sure to flush with saline or heparin per agency protocol. At my hospital we don't draw off of peripheral IVs, only central lines. I don't know the reason for the policy or I'd share it with you.

cassioo wrote:do you have a procedure for drawing off an existing line? Did you just draw from a HL or SL or did you discard anything before sending the lab?

i did draw 5ml off and discard then 10ml for lab and flushed with saline after. this is not usually done at my hospital, but most ivs don't give that good of blood return

jewelsrn2 wrote:i did draw 5ml off and discard then 10ml for lab and flushed with saline after. this is not usually done at my hospital, but most ivs don't give that good of blood return

I would just make sure there was a policy for drawing from IV's. If there is you're covered.

Mom-n-More wrote:If you're drawing off an IV lock you just want to be sure to keep it working. I'd discard about 5ml before getting the lab specimen, then be sure to flush with saline or heparin per agency protocol. At my hospital we don't draw off of peripheral IVs, only central lines. I don't know the reason for the policy or I'd share it with you.

Excellent post! I'd like to add, as mentioned refer to your SOP at your MTF. I draw from C/L & PIV's. Saline flush before, draw back waste, then draw back sample with seperate syringe. I always give the patient back the waste sample, followed by another flush. If, same PIV site with a continuous infusion I stop the drip a few minutes before the draw process, then immediately start back up after draw process completed. Most MTF's I've worked LVN/LPN's are not allowed to draw from access sites. Otherwise, if policy does not forbid C/L or PIV draw... GO FOR IT!. BTW, be sure the lab results were fairly consistent with previous results.

I do this all of the time. My ignorant manager printed off part of some article saying that you shouldn't be using peripheral IV's to draw blood with, but it also stated that you should make sure you're flushing them. EVERY STATE BOARD[B](8 that I've checked) RECOGNIZES DRAWING BLOOD FROM IV'S AS PART OF PRACTICE FOR BOTH RN'S AND LPN'S!!!! [/B] Not real sure it was a legitimate article, just one of her efforts to try to say what I do is wrong I think. I instruct most of my staff to draw from the IV if it is good enough to draw from, saving the patients extra sticks, and also ensuring that my staff are ensuring that they have patent IV's. I also NEVER flush with anything less than 5cc's, because a little 3cc flush can hide easily in a large patient, not letting you know that it's infiltrated. Though, if I don't get blood return, I flush cautiously anyhow. We have IV's go bad frequently, and I believe the major causative factor is lack of use. I've rarely had an IV that was continuously running go bad, only the ones that aren't being used. I also rarely place anything smaller than a 20g, because I may need that line for volume at any given time!!!!!

OhbowhntrRN wrote:I do this all of the time. My ignorant manager printed off part of some article saying that you shouldn't be using peripheral IV's to draw blood with, but it also stated that you should make sure you're flushing them. EVERY STATE BOARD[B](8 that I've checked) RECOGNIZES DRAWING BLOOD FROM IV'S AS PART OF PRACTICE FOR BOTH RN'S AND LPN'S!!!! [/B] Not real sure it was a legitimate article, just one of her efforts to try to say what I do is wrong I think. I instruct most of my staff to draw from the IV if it is good enough to draw from, saving the patients extra sticks, and also ensuring that my staff are ensuring that they have patent IV's. I also NEVER flush with anything less than 5cc's, because a little 3cc flush can hide easily in a large patient, not letting you know that it's infiltrated. Though, if I don't get blood return, I flush cautiously anyhow. We have IV's go bad frequently, and I believe the major causative factor is lack of use. I've rarely had an IV that was continuously running go bad, only the ones that aren't being used. I also rarely place anything smaller than a 20g, because I may need that line for volume at any given time!!!!!

Great post! BTW, I love the 10cc prefilled saline syringes.

We draw blood off of an IV after doing a discard tube first.

the 3cc syringes can cause too much pressure also blowing a site. (I think that's what happened to mine that also caused the clot in Nov) I know I saw 1 peson using a 3cc syringe a couple of times but I was trying to be a good patient and not say hey stop that :)

cassioo wrote:the 3cc syringes can cause too much pressure also blowing a site. (I think that's what happened to mine that also caused the clot in Nov) I know I saw 1 peson using a 3cc syringe a couple of times but I was trying to be a good patient and not say hey stop that :)

I've heard many people say this, BUT.....it's not true. The pressure exerted from a 10cc syringe will be much greater than that of a 3cc syringe. As far as what made an IV go bad....that could be anything, from bumping it on something, sleeping with it up under you, not being flushed regularly, etc.

OhbowhntrRN wrote:I've heard many people say this, BUT.....it's not true. The pressure exerted from a 10cc syringe will be much greater than that of a 3cc syringe. As far as what made an IV go bad....that could be anything, from bumping it on something, sleeping with it up under you, not being flushed regularly, etc.

do you have any of the literature that says it doesn't because that's what I was taught and all of the hospitals I work(ed) at have a policy about the size of syringe for flushes as well as for wound irrigation with dressing changes because the fluid force. I started looking things up this morning before work but had about 3 minutes and didn't get a chance to look at work today...I had a running mid-line and wasn't moving much so didn't have my arm under me so didn't see any reason for it to suddenly just go bad then end up with a clot so accounted it to the syringe size..maybe it was just time.

I agree that a 10cc syring will exert more pressure than a 3cc- I have worked in NICU in the past, and we always used 3cc syringes for line draws on neonates, because the pressure from a 10cc syringe is too great for their tiny vessels.

I just want to see the literature we're rewriting many policies because the way policies were for the past couple of years (with new DON) they were kind of pushed to the wayside. (NICU is a whole different ball game) and does it make a difference if it's a running IV or SL? When I went to PICC class (to learn to put them in) many moons ago it made a difference (I don't do them anymore) and Ports we use 10cc's. I don't have reference to journal of IV therapy (really don't have time to go to the medical library right now) so if anyone does have the literature direct me there please.

cassioo wrote:do you have any of the literature that says it doesn't because that's what I was taught and all of the hospitals I work(ed) at have a policy about the size of syringe for flushes as well as for wound irrigation with dressing changes because the fluid force. I started looking things up this morning before work but had about 3 minutes and didn't get a chance to look at work today...I had a running mid-line and wasn't moving much so didn't have my arm under me so didn't see any reason for it to suddenly just go bad then end up with a clot so accounted it to the syringe size..maybe it was just time.

In all honesty, you could use a little pressure guage(A sphygmometer might be ideal.....actually I may try this at work, and report results now that I think of it)and attach it to check the exact difference, but easy as any way to tell, without actuall #'s on what the difference is, is to take a syringe, and seal it to your palm or forearm, and draw back, do this with each, and I promise you'll see a difference. There is a big difference between an irrigation syringe, and a an IV luer syringe as far as pressure that can be exerted. That's like comparing apples to watermelons, not even a fair comparison.

IV's go bad sometimes, but I'm a firm believer that regular flushing of IV's results in a decrease in the number of IV's that go bad, by keeping them rinsed. When I've worked with staff who are "anal" about flushing IV's, I notice that their IV's go bad much less often.

I would be careful returning any blood from your waste syringe. You can easily introduce a clot (espicially if your pt has any clotting factors). It is safer to pitch your waste than to give it back....

will try to post the info next week I got it from someone in education and the phone number for the IV nurse assoc where you can call and talk to and IV nurse expert.

here we go from another site I haven't gotten back to work yet to get the numbers for all syringes but it's similar to why you can lay on a bed of nails but not on a single nail:

The force may appear to be greater... but the amount of pressure exerted to flush the lumen is actually less. The greater force you believe is being exerted is due to the smaller lumen of the line... not due to the size of the syringe.

"When infusing IV fluids via syringe, the key pressure issues are force and internal diameter. The hand exerts force (F) across the syringe plunger (A). Applying the same force, a 3mL syringe produces a higher pressure than a 10mL syringe. " Resistance and Pressue in Effective IV Therapy, http://www.baxter.com/doctors/iv_the...ssure.html#dyn

Here is the math: A 10cc syringe has a diameter (A) of 16mm. A 3cc syringe has a diameter (A) of 7mm. If, for example, the force/pressure exerted (F) is 50... then for a 10 cc syringe 50(F) divided by 16(A) = 3.125 psi. In the case of the 3cc syringe, 50 (F) divided by 7(A) = 7.15 psi.

THAT is the rationale for using the larger syringe for flushing... in this case, bigger IS better.

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We have also gone to a 3cc syringe prefilled NS flush that has a bigger barrel then the standard one..it's shorter and fatter so the volume of fluid is the same but the pressure isn't the same.

OhbowhntrRN wrote:I've heard many people say this, BUT.....it's not true. The pressure exerted from a 10cc syringe will be much greater than that of a 3cc syringe. As far as what made an IV go bad....that could be anything, from bumping it on something, sleeping with it up under you, not being flushed regularly, etc.

Well, on a side note; with patients having PICC lines you would not use anything less than a 10cc syringe.

cassioo wrote:here we go from another site I haven't gotten back to work yet to get the numbers for all syringes but it's similar to why you can lay on a bed of nails but not on a single nail:

The force may appear to be greater... but the amount of pressure exerted to flush the lumen is actually less. The greater force you believe is being exerted is due to the smaller lumen of the line... not due to the size of the syringe.

"When infusing IV fluids via syringe, the key pressure issues are force and internal diameter. The hand exerts force (F) across the syringe plunger (A). Applying the same force, a 3mL syringe produces a higher pressure than a 10mL syringe. " Resistance and Pressue in Effective IV Therapy, http://www.baxter.com/doctors/iv_the...ssure.html#dyn

Here is the math: A 10cc syringe has a diameter (A) of 16mm. A 3cc syringe has a diameter (A) of 7mm. If, for example, the force/pressure exerted (F) is 50... then for a 10 cc syringe 50(F) divided by 16(A) = 3.125 psi. In the case of the 3cc syringe, 50 (F) divided by 7(A) = 7.15 psi.

THAT is the rationale for using the larger syringe for flushing... in this case, bigger IS better.

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Excellent info!

hfergrn wrote:I would be careful returning any blood from your waste syringe. You can easily introduce a clot (espicially if your pt has any clotting factors). It is safer to pitch your waste than to give it back....

... not if their Hct is low ;) BTW, I always finish with a saline flush after giving back the waste.

Of course, if the patient's Hct is low you can ask for an order to have all blood draws sent via pedi tubes.

MagRedC5 wrote:Well, on a side note; with patients having PICC lines you would not use anything less than a 10cc syringe.

that's why I thought mine went bad it was a mid-line and had worked fine until a 3 cc syringe was used a couple of times by the same nurse. Maybe it was time for it to go bad but maybe the syringe helped it along the way.

cassioo wrote:that's why I thought mine went bad it was a mid-line and had worked fine until a 3 cc syringe was used a couple of times by the same nurse. Maybe it was time for it to go bad but maybe the syringe helped it along the way.

... maybe?