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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Pharmacology

Concepts Covered:

  • Medication Administration
  • Adult
  • Emergency Care of the Cardiac Patient
  • Intraoperative Nursing
  • Microbiology
  • Cardiac Disorders
  • Anxiety Disorders
  • Depressive Disorders
  • Vascular Disorders
  • Nervous System
  • Upper GI Disorders
  • Central Nervous System Disorders – Brain
  • Gastrointestinal Disorders
  • Immunological Disorders
  • Fundamentals of Emergency Nursing
  • Dosage Calculations
  • Understanding Society
  • Circulatory System
  • Concepts of Pharmacology
  • Studying
  • Hematologic Disorders
  • Newborn Care
  • Adulthood Growth and Development
  • Disorders of Pancreas
  • Respiratory Disorders
  • Postoperative Nursing
  • Pregnancy Risks
  • Neurological
  • Postpartum Complications
  • Substance Abuse Disorders
  • Noninfectious Respiratory Disorder
  • Bipolar Disorders
  • Peripheral Nervous System Disorders
  • Learning Pharmacology
  • Psychotic Disorders
  • Prenatal Concepts
  • Tissues and Glands
  • Test Taking Strategies

Study Plan Lessons

6 Rights of Medication Administration
ACLS (Advanced cardiac life support) Drugs
Adenosine (Adenocard) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Anesthetic Agents
Anti-Infective – Antifungals
Anti-Platelet Aggregate
Antianxiety Meds
Antidepressants
Atenolol (Tenormin) Nursing Considerations
Atropine (Atropen) Nursing Considerations
Barbiturates
Bariatric: IV Insertion
Basics of Calculations
Benztropine (Cogentin) Nursing Considerations
Bisacodyl (Dulcolax) Nursing Considerations
Buspirone (Buspar) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Celecoxib (Celebrex) Nursing Considerations
Codeine (Paveral) Nursing Considerations
Combative: IV Insertion
Complex Calculations (Dosage Calculations/Med Math)
Cyclosporine (Sandimmune) Nursing Considerations
Dark Skin: IV Insertion
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
Drawing Blood from the IV
Drawing Up Meds
Drug Interactions Nursing Mnemonic (These Drugs Can Interact)
Epoetin Alfa
Eye Prophylaxis for Newborn
Fentanyl (Duragesic) Nursing Considerations
Geriatric: IV Insertion
Giving Medication Through An IV Set Port
Glipizide (Glucotrol) Nursing Considerations
Guaifenesin (Mucinex) Nursing Considerations
Hanging an IV Piggyback
How to Remove (discontinue) an IV
How to Secure an IV (chevron, transparent dressing)
Hydralazine
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
IM Injections
Injectable Medications
Insulin
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin Drips
Insulin Mixing
Interactive Pharmacology Practice
Interactive Practice Drip Calculations
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 Infusions (Solutions)
IV Insertion Angle
IV Insertion Course Introduction
IV Placement Start To Finish (How to Start an IV)
IV Pump Management
IV Push Medications
Ketorolac (Toradol) Nursing Considerations
Labeling (Medications, Solutions, Containers) for Certified Perioperative Nurse (CNOR)
Lidocaine (Xylocaine) Nursing Considerations
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Maintenance of the IV
Mannitol (Osmitrol) Nursing Considerations
MAOIs
Medication Errors
Medication Reconciliation Review for Certified Perioperative Nurse (CNOR)
Medications in Ampules
Meds for Postpartum Hemorrhage (PPH)
Meperidine (Demerol) Nursing Considerations
Methadone (Methadose) Nursing Considerations
Methylergonovine (Methergine) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Mood Stabilizers
Nalbuphine (Nubain) Nursing Considerations
Needle Safety
Neostigmine (Prostigmin) Nursing Considerations
NG Tube Med Administration (Nasogastric)
NG Tube Medication Administration
Nitro Compounds
NRSNG Live | The S.O.C.K Method for Mastering Nursing Pharmacology and Never Forgetting a Medication Again
Nystatin (Mycostatin) Nursing Considerations
OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive
Olanzapine (Zyprexa) Nursing Considerations
Opioid Analgesics in Pregnancy
Oral Medications
Oxycodone (OxyContin) Nursing Considerations
Pain Management for the Older Adult – Live Tutoring Archive
Pain Management Meds – Live Tutoring Archive
Parasympathomimetics (Cholinergics) Nursing Considerations
Patient Controlled Analgesia (PCA)
Pediatric Dosage Calculations
Pentobarbital (Nembutal) Nursing Considerations
Pharmacodynamics
Pharmacokinetics
Pharmacokinetics Nursing Mnemonic (ADME)
Pharmacology Course Introduction
Phenobarbital (Luminal) Nursing Considerations
Phytonadione (Vitamin K) for Newborn
Pill Crushing & Cutting
Positioning
Procainamide (Pronestyl) Nursing Considerations
Propofol (Diprivan) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
Rh Immune Globulin in Pregnancy
Sedatives-Hypnotics
Sedatives-Hypnotics
Selecting THE vein
Spiking & Priming IV Bags
Starting an IV
Streptokinase (Streptase) Nursing Considerations
Struggling with Dimensional Analysis? – Live Tutoring Archive
SubQ Injections
Supplies Needed
Tattoos IV Insertion
TCAs
The SOCK Method – C
The SOCK Method – K
The SOCK Method – O
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method of Pharmacology 1 – Live Tutoring Archive
The SOCK Method of Pharmacology 2 – Live Tutoring Archive
The SOCK Method of Pharmacology 3 – Live Tutoring Archive
Tips & Tricks
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
Understanding All The IV Set Ports
Using Aseptic Technique
Verapamil (Calan) Nursing Considerations
12 Points to Answering Pharmacology Questions