Blood Draw Tips

NPO

NPO

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Is anyone drawing blood for lab testing in the field? We are supposed to draw for all MI, stroke, and sepsis patients.

We use vacutaners and a luerlock hub.
What is the best practice for doing this in the field? I've heard some people say it's useless prehospital because of the time delay, some say that's hogwash. Do they need to be chilled? Do I need to do it closer to the hospital? Not after fluids?

I'd also like to hear from RNs if there are any other patients where prehospital lab draws would really help you.
 
I always did them prior to fluid. Follow the tube draw order. Label the tubes as to the labs specs. Unlabeled bloods are discarded. You shouldn’t need to chill samples prehospital.
 
We can draw blood in the field, but I don't know of any medic I work with draws blood. In my clinical rotations if I was starting the line I would draw from the catheter. I never had a sequence, but I eventually remembered which ones needed X amount of blood. If the pt came in with a IV already pre-established I would use a blood tube as a "waste" to get the NS out of the lock. Then I would draw from the lock. You draw blood before fluid and if you have given fluid before drawing just remember to use a tube as a waste tube.

Oh and no they do not need to be chilled. I don't know how the cult does it but here we're supposed to put them in a bag and to timestamp, date, and sign the bag.
 
We routinely draw labs and AFAIK all our receiving hospitals use them. We tape them to the bag, and they're labeled by ED staff on arrival.
 
NPO said:
Is anyone drawing blood for lab testing in the field? We are supposed to draw for all MI, stroke, and sepsis patients.

We use vacutaners and a luerlock hub.
What is the best practice for doing this in the field? I've heard some people say it's useless prehospital because of the time delay, some say that's hogwash. Do they need to be chilled? Do I need to do it closer to the hospital? Not after fluids?

I'd also like to hear from RNs if there are any other patients where prehospital lab draws would really help you.
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Here they look at us funny sometimes if they're older than 30-45 minutes but no one can explain why that it is.

I find the luerlock vacutainers to be an enourmous pain (there are also pressfit varieties). It is possible to connect the vacutainer to an unprimed lock and connect the lock to the catheter hub like normal which certainly makes life less messy. However that creates more space that the vacuum must deal with so it may not work as well.
 
Tigger said:
Here they look at us funny sometimes if they're older than 30-45 minutes but no one can explain why that it is.

I find the luerlock vacutainers to be an enourmous pain (there are also pressfit varieties). It is possible to connect the vacutainer to an unprimed lock and connect the lock to the catheter hub like normal which certainly makes life less messy. However that creates more space that the vacuum must deal with so it may not work as well.
Click to expand...
We have the other press fit ones too, but like you said, messy.
 
At AMR in Hemet, we routinely drew blood for the ED, it is now required for stroke and MI, i believe. For suspected sepsis, i drew an addl 10cc in a syringe for quicker cultures. We drew 4 tubes, usually empty saline lock to vac as long you had a good IV. Here in San Diego where I work now, I got looked at sideways when I asked about field draws. Sounds like Hall is moving up, when I was there it was 3 lead ECG and stacked shocks still in the county protocols.
 
Tigger said:
Here they look at us funny sometimes if they're older than 30-45 minutes but no one can explain why that it is.
Click to expand...

There are a handful of potential problems with old blood but the main ones are that the blood coagulates (even in the heparinized tubes it can get "sticky" after a while) and/or the red blood cells start to break down.
 
Honestly, if my county's hospitals accepted field draws, all I'd really want is perhaps blood culture draws if you had an inkling that we might be dealing with a septic patient. At least this way we could get abx going a little earlier but realistically, we get draws done so quickly at my facility that it really doesn't speed things up all that much.
 
We used to draw bloods for our hospitals. Our main hospital (trauma, STEMI, stroke) started to use the iSTAT and stopped using field draws. With the other 2 hospitals they would toss EMS bloods in the trash 75% of the time so I just completely stopped. The last time I drew bloods was over 2 years ago.
 
We draw for strokes. This way blood can be sent to lab, while we take pt to CT.
We also draw cultures and lactate in sepsis pts. Cultures take a little more time, as the steps to keep everything sterile, take a bit longer. Lactate is only one we worry about time sensitivity. It must reach lab within 30 minutes of draw. I normally draw it, right before we arrive at ED.
 
jgmedic said:
At AMR in Hemet, we routinely drew blood for the ED, it is now required for stroke and MI, i believe. For suspected sepsis, i drew an addl 10cc in a syringe for quicker cultures. We drew 4 tubes, usually empty saline lock to vac as long you had a good IV. Here in San Diego where I work now, I got looked at sideways when I asked about field draws. Sounds like Hall is moving up, when I was there it was 3 lead ECG and stacked shocks still in the county protocols.
Click to expand...
They have moved up in many ways, the new medical director has made many chances, but I'm not there anymore, and as a matter of fact, they removed blood tubes from the ambulances a few years ago.
 
Remi said:
There are a handful of potential problems with old blood but the main ones are that the blood coagulates (even in the heparinized tubes it can get "sticky" after a while) and/or the red blood cells start to break down.
Click to expand...
That is my understanding as well, but there doesn't seem to be an agreed upon time frame and we are often drawing an hour before arriving at the ED.
 
NPO said:
We have the other press fit ones too, but like you said, messy.
Click to expand...
When I was still getting used to it, I'd slide a 4x4 under the cath to clean up the inevitable leakage.
 
Tigger said:
When I was still getting used to it, I'd slide a 4x4 under the cath to clean up the inevitable leakage.
Click to expand...

A absolute must when you’re a paramedic student making a mess in the ER. :D
 
Cultures: if needed, do them first. Fill aerobic tube first! Make sure you are performing excellent technique to prevent contamination.

My practice, (after/sans cultures), is to draw into an empty syringe and then use a transfer device (or pop the tube top) to fill tubes in prescribed order, but triaging based on how much blood I get vs what test the patient needs most.

Make sure you invert the tube a sufficient number of times (8-10 times except yellow top is 5-6 and blue is 3-4) to ensure the chemical additive mixes.

Know what samples your receiving lab will accept and which they want iced.
 
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