Blood that is drawn from a vein that has an intravenous iv line may be diluted by the iv fluid. I work in the er so i often have to start iv s, draw bloods, than repeat more bloods. However, there is not good research to support this recommendation and several studies have found it has no effect on arm swelling. Learning how to draw blood is essential to becoming a phlebotomist. Samples were analyzed for hemolysis using a hitachi automated spectrophotometer as well as by visual inspection. Why do nurses or phlebotomists let you pick which arm to. This fun and informative guide details the stepbystep process of taking a blood sample and makes a great. Our iv training arm helps you to practice and perfect your blood draw, venipuncture, phlebotomy, and iv skills before working on live patients. Heightening awareness that a tourniquet may still be in place, even if an iv is running well. So to avoid the issue, somebody makes a rule and there you go. Contamination of blood samples with iv fluids gives inaccurate results. Insert the needle at a 15 to 30degree angle into the vessel. We are permitted to draw bloods from the heplock during the initial insertion of the iv, but i was told that we are not supposed to draw bloods from the lock after that point.
All tubes should be gently inverted, labeled, and sent to the lab immediately after venipuncture. The course gives you the opportunity to perfect skills that virtually all medical professionals need to know and get it 100% right without having to risk working on a real. In most patients, it is very large and easy to access. Zlotowski et al 5 found that 16 of 19 laboratory tests agreed within 99 percent when venipuncture was compared with blood aspirated from peripheral intravenous catheter two. Blood samples drawn from iv catheters have less hemolysis. Best practices in phlebotomy who guidelines on drawing blood. Feel confident and look like an expert when performing phlybotomy procedures. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel. You can draw blood from the iv arm below the intravenous. When i was a paramedic we would obtain one red top tube if we felt the medical emergency was th.
But drawing blood during the initial set up is done all the time. Trubaby x has an optional arm left and right to facilitate ultrasoundguided iv. Nevertheless, it is still possible to get a good sample from an arm with iv therapy as long as you turn iv for at least 2 minutes prior to the procedure. How to draw blood drawing blood clinical nursing skills. How to find a vein when starting ivs or drawing blood tips. Our ed is going to be going from that back to starting iv with 1 or more stick, and drawing blood with a separate stick. Gives you a realistic training experience allowing you to learn how to draw blood like a professional before working on real patients. Although the technique of actually placing an iv is one that needs practice, the theory behind iv placement and management is didactic in nature and can be covered in a module such as this. Many venipunctures are routine, but you may occasionally encounter some difficult. If it is not possible to draw below the iv, these authors recommend turning off the iv infusion for at least three minutes and using the iv catheter to collect the blood. Video of venipuncture blood draw or collection using the bd vacutainer product play media.
Infant iv arm for ultrasoundguided vascular access practice. Our iv training arm helps you to practice and perfect your blood draw. The chapter includes background information section 2. Look at her lower arm to find the largest vein you can see. Its in the bend of the arm, so its not that great for ivs. Upon receiving orders to start an iv and draw blood, each of 12 study nurses obtained an envelope with 2 vacuum tubes randomly assigned as to which tube should be drawn first and which tube should be drawn second. Phlebotomy and iv practice arm practice and perfect venipuncture and blood draw procedurestechniques the apprentice doctor lightskin model. Who guidelines on drawing blood best practices in phlebotomy eng. If this does not happen then the needle has either not punctured the vein or the needle went through the. For example, generally speaking, you cant draw blood at or below an iv site for so many days after t. Blood draw during the insertion of a piv catheter not direct venipuncture for blood draw has been associated with higher hemolysis rate. Because of the fact that there are certain reasons you cant draw blood from a particular arm and the patient will have been told these reasons.
The authors performed a comparative study of the values of 18 serum constituents of blood specimens taken simultaneously from the arm into which an intravenous solution was flowing, using a site distal to the. Hemolysis rate in median cephalic and basilic veins 17% was comparable to that of median anterobrachial vein but lower than cephalic vein 29%. You can draw blood from the iv arm below the intravenous needle if you put a tourniquet in between. Iv therapy is a complex nursing treatment that most patients in an acute care setting have at one time or another during their hospital stay. Before drawing a specimen from a line, the infusion fluid should be completely stopped for several minutes and an amount of blood equal to three or more times. When clinically appropriate, limiting blood draws or iv starts until experienced iv team phlebotomy staff are available. Its generally not done after an iv has been established and has run for some time. This video shows the venipuncture procedure blood draw on a practice phlebotomy arm. In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for. However, if there is no alternative and an arm with an iv line in place must be used for venipuncture, try to choose a site away from and below the location of the iv. If properly inserted blood should flash into the catheter. The apprentice doctors iv practice arm feels like the real thing. Master setting up an ivline, basic injection techniques, properly collecting samples for laboratory testing, drawing blood, injecting local anesthetics, and much more. Phlebotomy and iv practice arm practice and perfect venipuncture.
I have worked in the ed both here and in another far larger hospital for approx 1. This will make the veins in her lower arm fill up with blood and be easier to find. And, in order to do so, one must learn and follow the proper steps to collecting blood from gathering the right equipment to transporting the sample to the laboratory. Document that the venipuncture was performed distal to below an infusion site. Did you know that drawing blood from a patients arm with intravenous infusion running has the potential risk for erroneous and misleading.
Performing a venipuncture on an arm containing an intravenous line. Therefore, an arm containing an iv should not be used to draw blood specimens if it can be avoided. This chapter covers all the steps recommended for safe phlebotomy and reiterates the accepted principles for blood drawing and blood collection. In healthcare, this procedure is performed by medical laboratory scientists, medical practitioners, some emts, paramedics, phlebotomists, dialysis technicians, and other nursing staff. If you cannot find a large enough vein in her lower arm, retie the cloth or tourniquet in the middle of her lower arm and look for a vein in the back of her hand, or just above her thumb at the wrist. The information given in this section underpins that given in the remainder of part. Anchor the vein by holding the patients arm and placing a thumb below the. Tightly place a tourniquet on the patients upper arm to prepare the location. Only tie the tourniquet tight enough to make the vein bulge. Only rns and above are allowed to touch vascular access so if theyre going to draw from an iv, an rn has to do it. For the complete blood count and 18 chemical parameters analyzed, only glucose values showed any difference between the belowthe iv draw site and a draw from the opposite arm.
Students should study venipuncture in books and watch licensed. Many organizations, like the american cancer society and the national lymphedema network, advise survivors to avoid blood pressure on the surgery side, if possible. Record the incident in the incident book if a specimen was lost, or persons were exposed to blood. Im going to have my 3hr gd testing done and i know they will have to draw blood 4 times, but im interested in knowing if you can actually draw blood from the same vein twice in one day. Best practices in phlebotomy who guidelines on drawing. Reasons why people miss veins when starting an iv or drawing blood. Once users accurately access the blood vessels within the model, positive blood flow provides feedback that the targeted vessel has been cannulated. Drawing blood from a peripheral iv student doctor network. Intravenous therapy or iv therapy as well as blood transfusions can lead to dilution of the specimen due to the fluid.
Pat the vein and find the best location in which to draw blood. Ivs in this site will be very uncomfortable for the. If blood flow does not stop quickly, checking for tourniquet placement. Grab the patients lower arm below site of puncture firmly to draw the skin taut and anchor the vein from rolling. Master venipuncture and intravenous iv techniques that virtually all medical professionals need to perform. A 2009 study by halm and gleaves showed the hemolysis rates of samples obtained from new piv is 12. This can ultimately affect the accuracy of the blood test results. Extend the patients arm and inspect the antecubital fossa or forearm. In hospitalized patients, do not take blood from an existing peripheral venous. Gently and quickly insert the needle into the chosen vein with a smooth motion so that the patient experiences the least amount of pain. I work in the er so i often have to start ivs, draw bloods, than repeat more bloods. In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of intravenous therapy or for blood sampling of venous blood. Get a howto course with stepbystep tutorials designed by practicing medical professionals with decades of experience to.