Drawing Bloods in the Field

[Turk II]

My per diem job makes medics and EMT-I's draw bloods in the field if we start an IV. We're supposed to do this to help the hospital out and expedite the hospital treatment of the patient.

I'll do anything I can to help speed up the treatment of the patient, but I simply can't understand why any paramedic service would insist on drawing bloods prehospitally. It's dangerous since now I have to connect, disconnect, and reconnect adaptors to the IV hub... it takes up my time and prevents me from doing other stuff on the way to the hospital.... it serves me absolutely no purpose....... most of the time the samples are hemolized by the time they get to the lab.....

Can anyone share with me the logic of drawing bloods in the back of an ambulance?

[jdemaio]

Yea, the nurses usually end up having to draw the blood anyways. The only reason I can see is for trauma for type and screen, so the patient can get blood products. If they don't have the type and screen, the patients automatically get O-, which is increasingly hard to come by. If the patient can get their own blood type, it's just better for everyone. I, peronsally, have worked with medics in systems that don't necessarily draw blood, but they get 2 10cc syringes of blood off the IV on trauma jobs, just to get the blood for the hosp. I don't like drawing blood, I think it's pointless, but if it's what the boss wants me to do, that's what I'll do.

[kjrff23]

To add a few other reasons to draw them. On a cardiac patient you can actually show the ED what the enzymes were at when you were on scene and the person was actually infarcting if they are having the big one. On an unconscious patient they can see what their glucose levels and check a tox screen and see if there were any narcs in thier system if you pushed narcan. The tops we use have anti-coagulants in them so clotting wasn't an issue on the way to the ED. We used to draw a red, tiger (marble), green, blue, and purple for the ED. I honestly can't tell you what the guys do now since we don't carry tops or vacutainer set-ups on the Engine Company ALS gear. We still carry all the colors on the rescues though.

[jdemaio]

To add a few other reasons to draw them. On a cardiac patient you can actually show the ED what the enzymes were at when you were on scene and the person was actually infarcting if they are having the big one. On an unconscious patient they can see what their glucose levels and check a tox screen and see if there were any narcs in thier system if you pushed narcan. The tops we use have anti-coagulants in them so clotting wasn't an issue on the way to the ED. We used to draw a red, tiger (marble), green, blue, and purple for the ED. I honestly can't tell you what the guys do now since we don't carry tops or vacutainer set-ups on the Engine Company ALS gear. We still carry all the colors on the rescues though.
Capt, I happen to mostly agree with Turk...I do not like drawing blood prehospitally. My full time job requires that when we are not doing calls that we assist in the ED, if needed. When we used to draw blood, the hemolyisis rate was high and the Pts would need a redraw anyways, and our transport times are no more that 5 minutes on an avearge basis. Clotting isn't the problem, it's hemolysis, the actual RBCs shearing apart...for whatever reason. As for the blood glucose, you should be getting a baseline on scene if your patient is unconcious...as for the tox screen, if you push narcan, it will only release the opiate from the opiate receptors, it will still be in the blood, it will still show on the tox screen. I agree with you about the enzymes, but the enzymes probobly won't resolve in a 10 minute transport time, and if they do...it's been a long time since the MI set in. I'm losing my train of thought...I guess I'm done for now.

[kjrff23]

I can see where you are coming from JD and actually when I was still on the bus I stopped drawing bloods because the ED would just throw them away when we got there. We do get a glucose read on the pt. on scene. I was talking about an A1C with the blood. As far as the narcan, it makes sense what you said but we never got that far into it in pharmacology as to what happens chemically after you push the med and get the desired effect. i think the 2 big reasons to draw in the field today are AMI and CVA patients, so you can speed up the thrombolytic screening process. I don't know a whole lot about labs and values so I don't know if hemolysis will affect what you can do for them but if the ED can see what they were doing on the scene and it decreases the door to drug time I think it might be worth it for them.

[fishy]

We draw blood from basically everyone who gets an IV. Its not a "must", but it has been around as far as i can think back and its sort of a gentlemen agreement with our EDs in the city. They pay for the "hardware" (those little syringe-like tubes... i'm in lack for a better term) and we draw the blood.
Its a set of 4 tubes (serum, edta, glucose, clotting) plus a fifth one for troponin, when there's an expected or obvious heart condition.

I dont mind, i takes less than a minute and usually the first question we get in the ED is "did you drew any blood?" so they are pretty happy about it.

Also, if theres a trauma patient the first thing we do is send someone (usually PD or FD) ahead of us, so that the trauma center can type and cross, till we're there.

[Turk II]

I think the biggest problem I have with drawing bloods in the field is the added exposure it puts on medics and EMTs - especially on a scene or in the back of a moving ambulance.

A few months ago my per diem service gave their annual OSHA training for blood borne pathogens. One part of the lecture listed the top five highest risks in regards to exposure potential and I think that number three was "Drawing or Handling Blood Samples."

Everytime I walk into one particular hospital I always get the same question... "Did you draw bloods?" Maybe it's just me but I have no problem saying, "Sorry, no I didn't."

[CornholioMedic]

Most of us don't do it in Detroit although I am sure a few still do it. Technically we are supposed to do pre-hospital draws for toxicology and cross type and match. They give us a Red top in our IV kits and drug boxes but almost no one ever does these draws. The only time that we did actual draws in the field was during our Poly-Heme study that was recently completed.

[princessmedic]

They give us the red tops here, I personally have never drawn blood in the field. It might be that the longest transport time I have is 7 min and the shortest is about 2. Alot of times they look at me funny when I do not have an IV started. There is only so much you can do in two min. I guess you either get vitals or an IV. not both!

[medicmade]

we can do a full set if we want, we also have the traponin and ckmb test kits. Depending on where you are in the county you can have some long transport times.

[medic pathetic]

They are debating having us draw blood for our STEMI pts. Last i heard it's still in discussions

[shfd739fm]

We carry vacutainers and the holders but we never draw ant blood,actually I think yhe only reason we carry them is because the state requires it(Mississippi).Last time I looked at them some were expired due to us never using them.The hospitals wouldnt take the blood even if we did do it.Last use i can remember was another medics blood for Hep Vac conversion check since he had just finished his series.

[bubbamedic]

We draw five tubes (six on traumas). With a luer adapter and a hub, there is little extra risk as long as we take the usual precautions. There are many benefits and it really is designed to help the hospital. Not to mention decreases the number of veins that are violated. Drawing from an established IV requires flushes, waste, and time. Hemolysis does happen from time to time, even in ERs. Usually from drawing from a partially kinked cath or one smaller than an 18 gauge needle, for the vaccum in the tubes are too great pulling the blood through the smaller diameter caths. We order plastic tubes as well. Things that have helped the patients and docs are things like blood work done on a possible seizure -- when drawn immediately after the seizure, the test can confirm if they did have one and provide clues to why since the blood returns to "normal" enroute to the ER.
Obviously the benefits will only occur if the hospital is in on the program and helps with labeling and tracking. There have been times when we got the only blood they can get for a awhile, for we took the only availiable stick.

[RichmondMedik]

If you don't want to draw labs in the field check with the hospital lab and ask what the policy is for non -employees drawing labs --- most won't run the sample if it is not drawn by an employee -- has to do with chain of evidence and insurance

[FF/EMTP1317]

Maryland state protocols mandate that we draw bloods on any unconscious, cardiac, or any pt with altered mental status with unknown cause. However, like it's already been mentioned, they'll coagulate before you get to the ED and I've actually had a nurse take the tubes I'd drawn and thrown them away becuase they were "dirty and probably haven't been done right" How can you screw up drawing bloods? But oh well. that's a nurse for you.

[medic pathetic]

Maryland state protocols mandate that we draw bloods on any unconscious, cardiac, or any pt with altered mental status with unknown cause. However, like it's already been mentioned, they'll coagulate before you get to the ED and I've actually had a nurse take the tubes I'd drawn and thrown them away becuase they were "dirty and probably haven't been done right" How can you screw up drawing bloods? But oh well. that's a nurse for you.

Well on traumas, you go in with a turkey baster and collect all you can suck up with it. Breaking the vacum seal of course. On medicals... well.. i guess you could stick someone else who knows the pt and get their blood instead bacause you know, at least they are concious and can give their consent.

[Dorkfish]

Well on traumas, you go in with a turkey baster and collect all you can suck up with it. Breaking the vacum seal of course. On medicals... well.. i guess you could stick someone else who knows the pt and get their blood instead bacause you know, at least they are concious and can give their consent.

Never seen someone use the turkey baster , but maybe a big sponge could come in handy .

[wiseguy4x4]

they use to give us the red tops for blood draws but that stop couple years back so the only blood draws i have done lately are for local pd if they have
for there blood draws for dui while there under volenteer or with court order

[paragoon]

Has anybody seen those machines that run the cardiac enzymes in about 10 minutes. They got one in the ER I used to work at about 6 months ago. All it takes is less than 1cc of blood from a purple (EDTA) tube. I'm sure that would be useful for those of us who routinely have transport times up to 30 minutes or more.