The 'gold" standard IMO is not to disrupt the endothelium of the vessel with blood draws.. but, INS dropped its statement discouraging this practice with its last revision. I would only agree to have this done on insertion. HOWEVER, 2011 INS states:
Sampling of blood through short term peripheral catheters has been found to be reliable for many routine blood tests, including coagulation studies, and may be considered for pediatric pts, those who require multiple lab tests including pts with an increased risk for bleeding &/or those with difficult vascular access.
If your institution does this rountinely, I would hope that the clinician would be drawing from the extention set attached to the catheter rather than the hub to hub method. This would create too much friction/damage to the intima of the vessel and start the phlebitis/thrombosis complication. An ext set allows one to be far enough away from that manipulation.
I would remove the old needleless connector, attach my syringe to the clamped ext set then draw my discard, then my sample,and then flush and place new connector.
There are no published studies that I have found pertaining to your question. Obtaining a blood sample when the PIV is inserted increases the likelihood of hemolysis and pseudohyperakalemia. There are many studies showing this problem. However, once inserted, a PIV can be used for obtaining blood samples. The risk of a pre-analytic error in a blood sample is the techniques used on insertion such as the lengthof tourniquet time. Your question did not include a vacuum tube and that is what I would recommend because it removes the need to transfer blood from syringe to the vacuum tube. Lynn
The 'gold" standard IMO is not to disrupt the endothelium of the vessel with blood draws.. but, INS dropped its statement discouraging this practice with its last revision. I would only agree to have this done on insertion. HOWEVER, 2011 INS states:
Sampling of blood through short term peripheral catheters has been found to be reliable for many routine blood tests, including coagulation studies, and may be considered for pediatric pts, those who require multiple lab tests including pts with an increased risk for bleeding &/or those with difficult vascular access.
If your institution does this rountinely, I would hope that the clinician would be drawing from the extention set attached to the catheter rather than the hub to hub method. This would create too much friction/damage to the intima of the vessel and start the phlebitis/thrombosis complication. An ext set allows one to be far enough away from that manipulation.
I would remove the old needleless connector, attach my syringe to the clamped ext set then draw my discard, then my sample,and then flush and place new connector.
There are no published studies that I have found pertaining to your question. Obtaining a blood sample when the PIV is inserted increases the likelihood of hemolysis and pseudohyperakalemia. There are many studies showing this problem. However, once inserted, a PIV can be used for obtaining blood samples. The risk of a pre-analytic error in a blood sample is the techniques used on insertion such as the lengthof tourniquet time. Your question did not include a vacuum tube and that is what I would recommend because it removes the need to transfer blood from syringe to the vacuum tube. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861