I am reaching out to our pediatric facilities. We are looking at developing guidelines to obtaining labs from peripheral IV's. Many nurses come from different places and have different process. We would like the same process for eveyone. Also is this common practice in your facility. I have done some literature search and find this is a practice that is done and apropriate lab values obtained. Would love to hear from you . Cindy
I have been researching that literature for many months now. It is far better to use an indwelling PIV for obtaining blood samples than to draw the sample at the time of PIV insertion. Tourniquet times longer than a minute, probing to find the vein, diffiiclut catheter advancement can all lead to falsely elevated potassium levels and falsely decreased sodium levels. This applies to all ages, not just peds. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks Lynn, we are currently seeing hgb and Hct values that don't seem correct from PIV. We are hoping with developing a guideline that the standardize practice will show that PIV to obtain lab values is ok.
Cindy Brown RN BSN CPN
IV Nurse Educator/Clinician
Studies show that there is much higher rates of hemolysis when the sample is drawn at the time of PIV insertion, so that could be the problem. Check with your lab to see how they classify hemolyzed samples. You can't really look at a tube full of blood immediately after drawing and tell if it is hemolyzed. It has to be centrifuged first, Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Also looking for the recommended waste when drawing labs from PIV. Cindy
Cindy Brown RN BSN CPN
IV Nurse Educator/Clinician
That is not well defined from what I have found. 1-2 mLs is suggested. With or without infusions through the same catheter - that would make a difference also. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
We recently put this into our vascular access policy. I remember the discussions, and that there was a general lack of literature on the topic. We went with a 5 mL forward flush, followed by aspirating 1 mL of blood for waste (after the blood enters the catheter). I think it was mostly based on what other facilities we doing. I can try to figure out who was in charge of that project and whether they found any useful info.
Matt
Thank Matt , That would be great, Thanks everyone for your input. Cindy
Cindy Brown RN BSN CPN
IV Nurse Educator/Clinician
Cindy, I talked to the folks who put that part of our policy together, and they said they just had to come to a consensus because there was no literature available on the topic. I can email you a copy of our policy it would be useful at all.
Matt,
Could I also obtain a copy of your policy for Lab draws from a piv and what resources you used to research the evidence.
Thank you,
Angela
FORHIM