We have been having some issues recently with lab results and would like to know if most people have phlebotomy present to put the specimen in the tubes when nurses draw from central/ picc lines. Or are the nurses responsible for placing the specimens in the tubes. Thanks, Mary
Most often, lab is present. We do this on purpose. Then they get what they need with the right tubes.
Sometime that doesn't happen, and we can do it.
Thanks.
Kathleen Wilson, CRNI
At our facility we limit the lab draws from our CVAD's to decrease the chance of CRBSI's occuring. If we draw from a peripheral line the phlebotomist may or may not be present.
I recently had an experience with a facility that refused to draw labs through a PICC which was placed for a combination of poor access and ABX therapy. This was refused due to policy. The ensuing discussion revolved around which was more important, preventing a statistically low incidence event(CRBSI,which may not even happen) or preventing phlebotomists from causing a daily traumatic event for the patient.(which indeed was happening)
It was disturbing that nurses were prioritizing the policy over the patients needs, I think we as vascular access nurses need to defend and often protect our patients from misguided policies. What does everyone else think?
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
I absolutely agree but at the risk of getting on a soapbox, I won't say much more. There is a lot of losing sight of what's best for the patient going on. (sorry for the twisted sentence)
At my facility, we do not recommend routine blood draws from CVAD. However, when I teach nurses, I tell them to look for a vein but I also tell them that if the patient does not have a visible/palpable vein, they can go for the CVAD as long as they are aware that they may be increasing the risk of CRBSI and occlusion and that they take every action to reduce the risk.
I tell the nurses that I fully trust their judgment. This being said, when the CVAD is used for blood drawing, the nurse isfilling the test tubes. The phlebotomist is not present.
Sincerely,
France Paquet, RN, MSC
Clinical Practice Consultant,
McGill University Health Center, Montreal, Quebec, Canada
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
We use CVLs frequently for drawing blood and it has always been the nurses responsibility to undertake the whole procedure - that includes placing into culture or specimen tubes - our labs have a manual which clearly outlines the minimum volumes required as well.
Karen Rankin
Clinical Nurse Consultant
the Children's Hospital at Westmead - Australia