UNCONTROLLED WHEN PRINTED
Indications
- The acquisition of pre-hospital phlebotomy has proven to result in shorter ED times by having the bloods sent to the lab earlier.
Contraindications
- Any patient whose clinical condition does not warrant IV cannulation.
- Children <16 years old.
Patient Factors & Considerations
- If blood fails to draw, assume an unsuccessful cannulation and re-attempt at a new site. Do not attempt to troubleshoot by flushing prior to blood draw.
- If blood flow appears slow or restricted, loosen tourniquet gradually to increase flow.
- Complete the following fields on the pathology request form: ‘clinical notes’ – case number and chief complaint i.e. chest pain, receiving ED and endorse with signature and AP number in ‘collection details’ field. Ensure the Unit No. is left blank and the patient details have been entered correctly.
Critical Care Paramedic only
- The only tube available on the Rescue Helicopter will be the 6 ml Pink top EDTA for whole blood haematology determinations and blood donor screening.
- Tube inversions ensure mixing of anticoagulant (EDTA) with blood to prevent clotting.
- To avoid mismatching, always use prior to administering any blood products.
- Ensure the sample is labelled accurately prior to arrival at the ED to limit potential misidentification.
Procedure
- All relevant infection control methods are to be utilised.
- Prepare equipment required:
- Refer to Vascular Access clinical skill for cannulation equipment
- Multi-Sample Adapter
- Vacutainer Tubes
- Lab Form
- Red ‘urgent’ biohazard bag
- Explain the procedure to the patient.
- Do not release the tourniquet (it may be necessary to slightly loosen however, if blood-flow is poor).
- Do not flush prior to obtaining the sample as this may dilute the sample.
- Secure the Luer-Lok multi-sample adapter to cannula / bung, and apply tape to support.
- Insert and fill vacutainer tubes in the following order (tubes marked as bold are standard across all ambulances):
| Light Blue | Sodium Citrate; for patients on anticoagulation medications, such as warfarin. Fill the tube to the line |
|---|---|
| Green | Lithium Heparin |
| Gold* | Serum Separation Tube, for biochemistry. Draw x2 for chest pain |
| Orange* | Rapid serum tube for troponins in regional labs |
| Light green* | Lithium Heparin Plasma with gel. |
| Purple | EDTA |
*May or may not be present, depending on your location.
- Gently invert 6-8 times. Do not shake.
- Remove tourniquet.
- Remove the multi-sample adapter and occlude the vein simultaneously (if “bung” not attached).
- Attach syringe, flush and secure as normal.
- Write patient details (Full name, DOB & case number), time and date of collection on tube and lab form in the appropriate area’s (see additional notes). Leave hospital numbers blank.
- Endorse all tubes and form by signing and include AP number.
- Place tubes and completed request form in biohazard bag.
- Handover sample tubes with the patient.
Success
Success
Discontinue
Discontinue
Additional Information
- The multi-sample adaptor is classed as a sharp.
- It should ideally be disposed of in the large sharps container. Alternatively it can be disposed of in the smaller sharps container by gripping the multi-sample adaptor by the Luer-Lok end and placing it open-end first into the sharps container.
- DO NOT place your finger into the chamber of the adaptor at any time.
- For more information, see PathWest site or PathWest Tube Collection Guide.
References
References
| Colour assist: |
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Document Control
Directorate
Clinical Services
Responsible Manager
Head of Clinical Services
Published Date
Review Date
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