IV, Lab Tubes, IV Sites

Learning Objectives

  • Discuss phlebotomy and necessary reasons for the procedure.

  • Describe phlebotomy and intravenous (IV) equipment.

  • Discuss the order of draw for blood collections.

  • Discuss considerations such as culture, age, body types, and personal preferences related to phlebotomy & IV therapy site selection.

  • Discuss IV infections and prevention strategies.

Phlebotomy Overview

  • Definition: Phlebotomy is the process of drawing blood for diagnostic or therapeutic purposes.

  • Equipment: Varies by facility but generally includes needles and tubes for blood collection. Commonly may start IVs using syringes and central line access tools.

Lab Tubes and Order of Draw

  • Order of Draw: Important to follow for accurate lab results:

    • 1. Yellow/Black: Blood cultures

    • 2. Light Blue: Citrate tubes for Protime, PTT, Thrombin time, D-Dimer, Fibrinogen.

    • 3. Red: Plain for Chemistries, Electrolytes, and Serology.

    • 4. Red/Gray or Gold: SST for Basic Metabolic panels and Comprehensive Metabolic panels.

    • 5. Green: Heparin for Albumin, Ammonia, Bilirubin, and Cholesterol.

    • 6. Lavender: EDTA for CBC and related tests.

    • 7. Gray: Fluoride for Glucose analysis and ETOH analysis.

Responsibilities When Drawing Blood

  • Protocol:

    • Double check the order before proceeding.

    • Identify the patient clearly to ensure correct sample collection.

    • Explain the procedure and necessity of tests to the patient.

    • Collect the specimen accurately, gently rotate the tube after collection.

    • Label the specimen immediately at the bedside.

    • Place the specimen in the designated bag and send it to the lab following facility protocols.

IV Access Sites

  • Common sites include:

    • Cephalic vein: Located in the forearm, proximal to the axillary vein.

    • Basilic vein: Found in the forearm, joins the brachial vein.

    • Median cubital vein: Superficial, lies over the cubital fossa and connects cephalic and basilic veins.

    • Brachial, Axillary, and Subclavian veins: Deeper veins used for various IV interventions.

Catheter Selection

  • Purpose of IV Catheters:

    • General fluid administration.

    • Administration of blood products.

    • Use in surgical patients and trauma.

  • Sizes (smaller number indicates larger diameter):

    • 16 gauge - Gray

    • 18 gauge - Green

    • 20 gauge - Pink

    • 22 gauge - Blue

    • 24 gauge - Yellow

Normal Saline Flush

  • Components: Mixture of salt and water.

  • Uses:

    • Flush residual medications or fluids through IV lines.

    • Keep peripheral IV (PIV) line patent.

    • Reduce infection or occlusion risk.

    • Scheduled flushes ensure IV remains open and free from blood clots.

CDC Guidelines for Infection Prevention

  • Implement the following protocols:

    • Verify physician's order for procedures.

    • Maintain hand hygiene.

    • Use aseptic technique for peripheral lines and sterile technique for central lines.

    • Preferred skin prep using Chlorhexidine.

    • Sterile stylet must only contact skin once.

    • Perform assessments every 4 hours minimum.

    • Begin IV access distal and progress proximal, avoiding marked areas.

    • Secure device properly to prevent movement and displacement.

Documentation Practices

  • Always document actions clearly, e.g.:

    • "Inserted 18g PIV in right antecubital; labs drawn; normal saline flush 3-5 mL patent; no signs of irritation or infection; secured with a transparent dressing; patient tolerated well."

    • Documenting details ensures continuity and quality of care.

Infection Risks and Control

  • Local Signs/Symptoms of IV Infection:

    • Edema, redness, heat, pain or tenderness, and loss of function.

  • Systemic Signs/Symptoms:

    • Fever, malaise, anorexia, nausea, vomiting, and lymph node enlargement.

  • Control Measures: Include policies to minimize risk of healthcare-associated infections, employing both medical and surgical asepsis techniques to protect patients and staff.

References

  • Cooper, K., & Gosnell, K. (2023). Foundations and adult health nursing. (9th ed.). St. Louis, MO: Elsevier.

  • Ford, S. (2022). Roach’s introductory clinical pharmacology. (12th ed.). Philadelphia PA: Wolters Kluwer.

  • Perry, A., Potter, P., & Ostendorf, W. (2020). Nursing Interventions & Clinical Skills (7th ed.). St. Louis, MO: Elsevier.