Do you think it is good practice to draw bloods in the field?

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LifeOfAMedicStudent

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Some EMS agencies I have worked for draw blood in the field (red, blue, green, lavender) while starting their line. That is what many emergency departments do anyways, and it saves the patient from having a second stick.

However, I have been told in Tennessee this practice is forbidden unless it is for a DUI blood draw. Although, some EMS agencies do this anyways regardless.

But if the patient must be stuck a second time in the ED for blood draws, aren't we doing more harm than good by starting a line in the fiele if there is no life threatening emergency or if we are not giving meds?

At the same time, I have also been told that the blood drawn in the field may be rendered useless because it can hemolyze or coagulate.
 
Many hospitals will just draw blood from the line that is already established by the EMS screw so a second stick is not needed (unless they are drawing blood cultures).

We are able to draw bloods for the hospital. We don't any protocols for DUI blood draws nor have I heard of a medic in our county being asked.

With that being said I personally do not draw bloods anymore. One of our hospitals started using the iStat machines and do not accept any prehospital bloods anymore. The other 2 hospitals I transport to are hit and miss with bloods. Sometimes they will use them and other times they will toss them. I'm not a fan of wasting things so I don't bother anymore.

We also do not start any "complementary" IVs anymore. So if the patient does not need IV fluids, IV medications, and is stable then no IV is started even if we know the hospital will eventually start one.
 
DesertMedic66 said:
Many hospitals will just draw blood from the line that is already established by the EMS screw so a second stick is not needed (unless they are drawing blood cultures).

We are able to draw bloods for the hospital. We don't any protocols for DUI blood draws nor have I heard of a medic in our county being asked.

With that being said I personally do not draw bloods anymore. One of our hospitals started using the iStat machines and do not accept any prehospital bloods anymore. The other 2 hospitals I transport to are hit and miss with bloods. Sometimes they will use them and other times they will toss them. I'm not a fan of wasting things so I don't bother anymore.
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Some of them will draw from the same line, while others will not. If they do, they must draw up and dispose of at least 10cc of blood first. And the question comes into play, does this still do more harm than good rather than the hospital starting a line when the patient arrives?
 
LifeOfAMedicStudent said:
Some of them will draw from the same line, while others will not. If they do, they must draw up and dispose of at least 10cc of blood first. And the question comes into play, does this still do more harm than good rather than the hospital starting a line when the patient arrives?
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Disposing of 10mL of blood is not doing any harm. Ours will dispose of ~5mL.
 
We stopped years ago cause the nurses typically threw it away, as Desertmedic said, we just dont bother.

We do draw cultures in suspected sepsis for the hospital that owns our service. The competing hospital wont play nice so they get to draw their own cultures after weve given antibiotics.



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If they would use them, I would draw them; but they just throw them away and draw their own so screw it.

Whether the samples we drew would still be any good is a question of transport time, and thus every bodies favorite answer, it depends.
 
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I don't have the ability to draw blood and most of the time I wouldn't anyway if I could. I am kinda in the same boat as desertmedic in not just starting complimentary lines. If I don't need to give anything and don't foresee any issues in the next 10 minutes, I don't. The exceptions are legitimately sick people of course, even if I won't be giving anything (stroke, etc). Otherwise, they can do what they want.

Even if they couldn't use our lines, I'd hardly say starting a second line is doing harm. Uncomfortable, sure, but not harmful.
 
I've never heard of pre-hospital blood draws for lab use in this area, though the idea of putting iSTATs on trucks has been tossed around. From the ER perspective, it would be a QA nightmare. Between hemolyzed samples and contaminated blood cultures, it would be difficult to educate those who need it. Additionally, I'm sure billing would also be a nightmare.

With iSTATs I couldn't say whether it is worth it or not, as I couldn't tell you how to respond to half of the results on a BMP. Trop and lactic, maybe, but I don't see those results having an effect on pre-hospital patient care unless with patient was asymptomatic. That said, these tests take 5-10 minutes each, and I'd be curious to see how well the iSTAT does in a bouncy code 3 ambulance.

None the less, I feel the logistics of it all would really hinder the process and only result in wasted expenses on both sides.
 
In DE, we drew bloods on every IV and some of the hospitals would use them, others not. I heard there was a joint commission issue with us not labeling the lab samples correctly, but that was just scuttlebut.

Here in GA, nope. Although, a few months ago there was talk of having us do the legal draw for DUIs. I havent heard any more about that.
 
Most of the hospitals in my area ask that we draw blood if we can. However, they only use those for labs and draw blood from our line to use on the iSTAT. They dispose of 10ml before the draw to avoid diluted blood. They do start a new line if they're getting blood cultures, though.
 
EMS field draws...I feel like these are an old-school practice. I'm suspicious because I can't exactly follow the cost/benefit calculus. Not to mention, there is a paucity of evidence.
 
GMCmedic said:
We do draw cultures in suspected sepsis for the hospital that owns our service. The competing hospital wont play nice so they get to draw their own cultures after weve given antibiotics.

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I'm just curious as to what you mean by "won't play nice?" Also, how long are your transport times? I'm asking because unless you have some long transport times, it's probably better to wait for them to draw the blood cultures first. Otherwise, you're screwing over the patient.
 
medichopeful said:
I'm just curious as to what you mean by "won't play nice?" Also, how long are your transport times? I'm asking because unless you have some long transport times, it's probably better to wait for them to draw the blood cultures first. Otherwise, you're screwing over the patient.
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They dont want to supply us with their culture tubes. Transport times can range from 5 minutes to an hour.

I dont disagree with you, this is our Medical Directors decision.

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IMHO if the ED is willing to accept and run labs from blood you have drawn, then I think absolutely you should draw bloods as often as possible with every IV start you do. If you're going to be giving antibiotics, then it should be an absolute to get blood cultures at least! Unfortunately too often the ED doesn't take field bloods...
 
medichopeful said:
I'm just curious as to what you mean by "won't play nice?" Also, how long are your transport times? I'm asking because unless you have some long transport times, it's probably better to wait for them to draw the blood cultures first. Otherwise, you're screwing over the patient.
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This is why you draw the cultures in the field, prior to abx administration. It is in no way harming the pts. Actually helping your sepsis pts.

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reaper said:
This is why you draw the cultures in the field, prior to abx administration. It is in no way harming the pts. Actually helping your sepsis pts.

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Drawing blood cultures in the field is an excellent idea and one that I'm all for! Per the post I was responding to, the service I was questioning was providing ABX prior to drawing blood cultures due to one hospital not giving them the blood culture tubes they use. That's what is hurting or "screwing over" patients, giving ABX before the blood cultures. Unless there's a crazy long transport time, it's better to hold off on the ABX and let the hospital draw them before they start treatment.
 
When I started in EMS (back in the 90s), paramedics drew bloods all the time. as time progressed I saw fewer paramedics drew blood to send to the lab. I was told this decline was due to the hospital refusing to send the blood to the lab for testing purposes. So as fewer ERs would accept the draws, the providers just stopped doing them.
 
Sorry, long night. Yes, I would not give abx unless you can draw cultures first. The Lab tech would hunt you down and kill you in your sleep!!!

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