In the Emergency Center or Pediatrics it is very common that we are asked to draw labs with our venipuncture so pt. does not have to be stuck "twice" Actually, if they are calling the IV Team, they probably have been stuck unsuccessfully already. What is the preferred technique however?? I don't feel the INS Standards address this. Is it alright to connect a "dry " sterile extension set to your angiocath hub, maintaining sterility, and apply a vacutainer at the other end?? We have never had complaints from lab about inaccurate results.If the pt. is an adult, it is easy to connect the vacutainer directly to the angiocath to draw ,and then apply your primed extension and flush with saline. With children/babies there is less manipulation at the insert if all the motion is at the end of the extension, then after you have obtained your sample, disconnect the vacutainer and after scubbing the hub, flush with N/S. We just swapped to Max-Plus by Alaris,and they say prime your extension first(it seems to be mostly for that positive -pressure valve itself to "lubricate"). If we did use a primed extension, we would have to draw a waste-sample, couldn't draw an initial blood culture ?? The resolution was to have EC use non-bonded Pediatric Alaris extension sets where the slide clamp is closed, the valve is taken off, and the vacutainer is applied at the end. A new ,sterile pre-primed or lubricated valve would be applied after blood samples collected and the line would be flushed.What is the issue with drawing through a "dry" extension set? Thank You for the expert advise I know I am going to receive from all my fellow nurses who are passionate about Infusion Therapy !
You are asking a question that is at the procedure level. A standards of practice document is not written at the detail level of any procedure. The INS standards do not address these details for that reason. Also, there is a lack of any studies on these details, therefore it does not rise to the level of a standard of practice. You must make your own decisions about these steps. I can definitely understand your reasons for using an extension set on all PIVs! I strongly support this practice for all the reasons you mentioned. I also understand the waste issue if the extension set has been primed. I have seen the dry extension set used. If you can eliminate the risk of air being pushed into the bloodstream and ensure that what all nurses will be doing is aspriating first, this could be the answer. But even a small amount of air can cause small emboli which damages venous endothelium. Could you use a dry extension set with a vacuum tube holder attahced to the extension set, draw the blood sample from the dry set, detach vacuum tube holder, then add a primed needleless connector, and flush? If you say the manufacturer recommends priming their device before use, this may solve the problem. Again, there is no standard because research has not established what that standard should be. So benchmarking against what others are doing is the best method on this questions now. 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
We use a dry extension set with a luer adapted vacuum tube holder attached to the extension set, draw the blood sample from the dry set, clamp the extension set, detach the vacuum tube holder, clean the hub with alcohol and then add a primed needleless connector, and flush. In the ED environment we usually do ultrasound assisted PIV insertions about 75% of the time. We do not have phlebotomists so in the inpatient areas the vascular access department does the same procedure about 10X a day.
Robbin George RN VA-BC