Drawing Blood from the IV

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Chance Reaves
MSN-Ed,RN
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Outline

Nursing Points

General

  1. Candidates for drawing blood through the IV
    1. Most EBP recommends against drawing through IVs
    2. Candidates for this procedure are:
      1. Difficult access
      2. Patient noncompliance
      3. Those getting a freshly IV placed
    3. Only draw through an IV when necessary
  2. Prior to collecting a blood sample
    1. Verify the order for the need to collect blood
    2. Look for other options of collecting blood that do not require another needle stick
      1. Central line access/midline/PICC
  3. Drawing the blood of a Fresh IV is best
    1. Start the IV and secure
    2. Attach a vacutainer
    3. Collect blood specimens that are ordered
    4. Disconnect vacutainer and flush the line
    5. The IV site must be
      1. Patent
      2. Must have blood return
      3. Must have an infusion that can be paused
    6. Consider alternate options if
      1. The IV does not flush easily
      2. There is no blood return
      3. The infusion cannot be stopped
  4. Tips and Tricks
    1. Don’t withdraw the sample too quickly
      1. Can cause hemolysis of the sample, requiring a redraw
    2. For samples that have slow blood return
      1. The hub of the catheter can be manipulated up and down slightly
        1. Be careful to not dislodge the catheter

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Transcript

Okay. Guys, in this lesson we’re going to take a look at when you would actually draw blood from an IV. The first thing you need to know is it’s not recommended based on evidence. There’s a lots of things that are out there that show that this can actually cause a lot of problems. There are devices on the market that allow you to draw blood through a peripheral IV, but there’s a lot of training, uh, and there’s just more that goes into it. However, that being said, if you have the opportunity when you first go to insert an IV that your patient has good blood return, it doesn’t hurt anything because it’s so fresh to actually get a sample. The first thing that you need to do before you even put the IV in is to make sure that you have an order for all your labs. 

You want to make sure that you have an order for the IV as well, but also make sure that you know specifically what blood tubes you need. Are you going to need a purple top? Are you going to submit a CBC or lactate? There’s lots of things that you can do off that fresh stick, but the thing that you want to remember is that as you do it, you want to make sure that you’re not causing damage to the IV itself. If you’re getting blood this way on that patient’s IV stick, make sure that you’re using minimal negative pressure. The reason you want to do this is you also don’t want to collapse that brand new IV that you placed caused patient problems because of a collapsed vessel and now you have an IV that doesn’t work. But the other thing is you don’t want to cause problems with your blood sample. 

That negative, that extreme negative pressure can actually cause a lysing of those cells and then you’re going to have to redraw anyway and it becomes a big pain. So just make sure that it’s a nice fluid motion with minimal negative pressure. If you get resistance and it stops flowing back, call it a day and make sure that you get blood by other means necessary, whether that’s a fresh stick which is actually indicated, or if your patient has a different type of, uh, access. Maybe central access with several different lumens, maybe a pic, a, there are several different options that you can go for. It doesn’t always have to be through that PIV. Now take a look at this video to see how to safely draw blood from an IV, but you get your IV set in the vein. What you’re going to do is you’re going to grab the flush and you’re going to actually withdraw the sample that you need, and once you get that sample, the first thing you’re going to do is waste three to five miles, and then you’re going to pull the actual sample that you need.

After that, make sure you hook up a new flush and you want to flush that line that you just worked really hard to get. Grab a new flush in. The other thing you want to do is make sure that you’re not clamped and to make sure that line stays Peyton. You’re going to reflush and then after that, you’re going to make sure that you spend the time securing that IV. Now that you’ve got your sample. What you’re gonna do is take this blunt tip plastic Canyon and you’re gonna attach it to the sample syringe. After you do that, then you’re going to do is grab the necessary vacuum tanners or vials that you need. Use that blunt tip. You don’t want to poke yourself, apply pressure and then what’s going to happen is you’re going to fill up this a tube, the blood tube and what you want to do is you want to continue filling that blood tube all the way up as full as it needs to be.

This is indicated on the label with that little black Mark you want to fill to that designated line. One other tip that you can employ is if your patient does start to have a little bit of a sluggish blood return, which you can actually do is manipulate the hub of the catheter up and down just slightly to maybe change the angle and you can sometimes get some blood back from that, but again, if it doesn’t work, call it a day and move on. I hope that these tips have been helpful. Now go out and be your best selves today. And as always, happy nursing.

 

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  • Circulatory System
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  • Integumentary Disorders
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  • Labor Complications
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Study Plan Lessons

EKG (ECG) Course Introduction
Fluid & Electrolytes Course Introduction
Respiratory Course Introduction
Electrical A&P of the Heart
Respiratory A&P Module Intro
Electrolytes Involved in Cardiac (Heart) Conduction
Fluid Pressures
Lung Sounds
Alveoli & Atelectasis
Alveoli & Atelectasis
Fluid Shifts (Ascites) (Pleural Effusion)
Gas Exchange
Gas Exchange
Isotonic Solutions (IV solutions)
Hypotonic Solutions (IV solutions)
Hypertonic Solutions (IV solutions)
Preload and Afterload
Performing Cardiac (Heart) Monitoring
Lung Diseases Module Intro
The EKG (ECG) Graph
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology for Asthma
EKG (ECG) Waveforms
Sodium-Na (Hypernatremia, Hyponatremia)
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Calculating Heart Rate
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Chloride-Cl (Hyperchloremia, Hypochloremia)
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology for Pulmonary Edema
Phosphorus-Phos
Normal Sinus Rhythm
Normal Sinus Rhythm
Respiratory Infections Module Intro
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Influenza (Flu)
Sinus Bradycardia
Sinus Bradycardia
Sinus Tachycardia
Sinus Tachycardia
Nursing Care and Pathophysiology for Tuberculosis (TB)
Atrial Flutter
Pacemakers
Nursing Care and Pathophysiology of Pneumonia
Atrial Fibrillation (A Fib)
Atrial Fibrillation (A Fib)
Coronavirus (COVID-19) Nursing Care and General Information
Premature Atrial Contraction (PAC)
Supraventricular Tachycardia (SVT)
Premature Ventricular Contraction (PVC)
Premature Ventricular Contraction (PVC)
Ventricular Tachycardia (V-tach)
Ventricular Tachycardia (V-tach)
Ventricular Fibrillation (V Fib)
Ventricular Fibrillation (V Fib)
1st Degree AV Heart Block
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
3rd Degree AV Heart Block (Complete Heart Block)
Oxygen Delivery Module Intro
Hierarchy of O2 Delivery
Nursing Care and Pathophysiology of Hypertension (HTN)
Artificial Airways
Artificial Airways
Airway Suctioning
Airway Suctioning
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Respiratory Trauma Module Intro
Blunt Chest Trauma
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Cardiogenic Shock
Chest Tube Management
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Pulmonary Embolism
Respiratory Procedures Module Intro
ABG (Arterial Blood Gas) Interpretation-The Basics
ABG (Arterial Blood Gas) Oxygenation
ABG Course (Arterial Blood Gas) Introduction
ABGs Nursing Normal Lab Values
ABGs Tic-Tac-Toe interpretation Method
Acute Coronary Syndrome (ACS) Module Intro
Bariatric: IV Insertion
Base Excess & Deficit
Blood Flow Through The Heart
Bronchoscopy
Cardiac A&P Module Intro
Cardiac Anatomy
Cardiac Course Introduction
Cardiovascular Disorders (CVD) Module Intro
Chest Tube Management
Combative: IV Insertion
Coronary Circulation
Dark Skin: IV Insertion
Drawing Blood from the IV
Fluid Compartments
Geriatric: IV Insertion
Giving Medication Through An IV Set Port
Heart (Cardiac) Failure Module Intro
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Sound Locations and Auscultation
Hemodynamics
Hemodynamics
How to Remove (discontinue) an IV
How to Secure an IV (chevron, transparent dressing)
Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)
IV Catheter Selection (gauge, color)
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
IV Drip Administration & Safety Checks
IV Drip Therapy – Medications Used for Drips
IV Insertion Angle
IV Insertion Course Introduction
IV Placement Start To Finish (How to Start an IV)
Lactic Acid
Lung Sounds
Maintenance of the IV
Metabolic Acidosis (interpretation and nursing diagnosis)
Metabolic Alkalosis
MI Surgical Intervention
Needle Safety
Nursing Care and Pathophysiology for Aortic Aneurysm
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology of Pneumonia
Pacemakers
Performing Cardiac (Heart) Monitoring
Positioning
Potassium-K (Hyperkalemia, Hypokalemia)
Preload and Afterload
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Alkalosis
ROME – ABG (Arterial Blood Gas) Interpretation
Selecting THE vein
Shock Module Intro
Supplies Needed
Tattoos IV Insertion
Thoracentesis
Tips & Tricks
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
Understanding All The IV Set Ports
Using Aseptic Technique
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Vent Alarms