- Patients to be transported to an Emergency Department with successful Peripheral IV Access or External Jugular Access whose clinical presentation warrants pre-hospital blood sample collection.
- Patients 16 years and older
- Any patient whose clinical condition does not warrant IV cannulation.
- Where prehospital blood collection will delay life saving treatment
- Patients <16 years old.
Key Aseptic Terms for Prehospital Blood Sampling
- Key Sites:
- Bung
- Key Parts:
- Multi-sample Adapter
- The acquisition of pre-hospital phlebotomy has proven to result in shorter ED times by having the bloods sent to the lab earlier.
- Failure to draw blood does not necessarily indicate failed cannulation. Consider troubleshooting by either manipulating patient limb or using gentle movement of cannula to attempt to induce flow.
- 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.
- 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.
Preparation
Skill to be performed after successful Vascular Access attempt.
Patient:
- Explain procedure to patient and gain consent where required.
Equipment:
- Multi-Sample Adapter
- Vacutainer Tubes
- Lab Form
- Red 'urgent' biohazard bag
- 2% CHG 70% alcohol swab (If required for cleaning key sites and key parts)
Procedure
- Perform Hand Hygiene, don fresh gloves.
- 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.
- Clean the bung with 2% CHG 70% alcohol swab for 15 seconds and allow to air dry.
- DO NOT TOUCH THE ATTACHMENT POINT OF THE MULTI-SAMPLE ADAPTOR OR THE BUNG PRIOR TO CONNECTING.
- If attachment point of multi-sample adaptor has been touched prior to use, clean with 2% CHG 70% alcohol swab for 30 seconds and allow to air dry.
- Secure the Luer-Lok multi-sample adaptor to bung.
- 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 adaptor.
- If bung has been touched during removal of multi-sample adaptor, clean bung with 2% CHG 70% alcohol for 15 seconds and allow to air dry.
- 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.
- 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.
| Settings | |
|---|---|
| Extended Care: | |
| Colour assist: | |
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