What Vacutainers Do You Carry in your IV Kits?

[Arizonaffcep]

Where I work now, the light blue (sodium citrate) is coags, d-dimer, and genetic studies (on ice), gold top is one with the serum separator thing and it does liver, vitamins, serum preg, all kinds of things-some need to be protected from light (vit. studies), dark green lithium heparin is ETOH, venus lactate (on ice), mint top, lithium heparin with serum separator is chem pannel, 3ml lavender blood pannel (edta), 6ml lavender (edta) is for type & screen/cross and other blood product screens. We have separate blood cultures (orange top is arobic, green is anerobic), we also have grey tops, but we don't use them in my department. We also have heprin filled syringes for blood gasses.

[VentMedic]

We also have heprin filled syringes for blood gasses.

Are you sticking arteries routinely on EMS calls? Ice? Can you guarantee analysis within 20 minutes from the draw?

What are you using to clean the puncture site for blood cultures?

[Arizonaffcep]

Are you sticking arteries routinely on EMS calls? Ice? Can you guarantee analysis within 20 minutes from the draw?

What are you using to clean the puncture site for blood cultures?

YES. I work FT in the ED at UMC in Tucson. Artery sticks are out of our scope of practice. But thanks...

For cleaning the culture site...I usually just spit on the area, rub it in and make sure to lick the needle on the butterfly... :twisted:

chlorhexadine gluconate...70% Alcohol, 2% chlorhexadine gluconate. They come as swabs.

[UMSTUDENT]

We draw blood in our service, but it really depends on whether it gets used or not.

I personally believe that labs should be drawn by trained professionals. I was never taught all the intricacies of blood draw and I definitely can see how EMS labs can be skewed.

For instance I have been told that if you used a alcohol prep during skin preparation that any testing for ETOH is invalid, at least in certain states. I know for a fact that the chain of custody is extremely important in DUI/DWI cases.

Our service used to use vacutaner adapters that connected right to the catheter, allowing blood to shoot, under relatively high pressures, into the vacuum tubes. Apparently this was discontinued after it was revealed that lab values were off. Apparently RBCS would lyse, etc under the pressure.

[Arizonaffcep]

For instance I have been told that if you used a alcohol prep during skin preparation that any testing for ETOH is invalid, at least in certain states. I know for a fact that the chain of custody is extremely important in DUI/DWI cases.

Ya...its another point of lawyers being dumb. From my understanding, the isopropyl alcohol CANNOT be detected when running a BAL, because it is a totally different form of alcohol, and requires a different test to find the level. This being said, the best option is iodine of some sort. The PD test kits that are used here come with them, and when I draw for PD (AZ law says it's ok for PD to get a sample of blood from a PT without a warrant IF there is a draw being done for medical purposes) I use the iodine swab that comes in their kit...I figure it just makes everything a little easier.

[VentMedic]

We carry light blue, light green, gold, lavender and a tiger top. However, these are only good for a couple of hospitals around town, most don't like prehospital to draw labs for them...for whatever reason.

Where I work now, the light blue (sodium citrate) is coags, d-dimer, and genetic studies (on ice), gold top is one with the serum separator thing and it does liver, vitamins, serum preg, all kinds of things-some need to be protected from light (vit. studies), dark green lithium heparin is ETOH, venus lactate (on ice), mint top, lithium heparin with serum separator is chem pannel, 3ml lavender blood pannel (edta), 6ml lavender (edta) is for type & screen/cross and other blood product screens. We have separate blood cultures (orange top is arobic, green is anerobic), we also have grey tops, but we don't use them in my department. We also have heprin filled syringes for blood gasses.

YES. I work FT in the ED at UMC in Tucson. Artery sticks are out of our scope of practice. But thanks...

For cleaning the culture site...I usually just spit on the area, rub it in and make sure to lick the needle on the butterfly...

What's with the attitude? You put two posts up with the first being for prehospital. You didn't say your second post was for tubes used in the hospital ED.

Phlebotomists can draw arterial blood in some states. Thus, if the ED techs have a phlebotomy cert in some places they also can draw arterial blood.

As far as doing ABGs on a truck, some that double for 911 and CCT do have the capability of using a Point-of-Care machine. You will also see this occasionally on HEMS. It has its pros and cons. I just thought your service might have been one trying to provide more advanced skills. Thought wrong.

If you are that easily offended by questions, I hope that you will not encounter JCAHO and CLIA inspectors while working in the hospital. They aren't as tolerant or lenient as those you may have encountered while working as a Paramedic with the FD.

[Arizonaffcep]

What's with the attitude? You put two posts up with the first being for prehospital. You didn't say your second post was for tubes used in the hospital ED.

Phlebotomists can draw arterial blood in some states. Thus, if the ED techs have a phlebotomy cert in some places they also can draw arterial blood.

As far as doing ABGs on a truck, some that double for 911 and CCT do have the capability of using a Point-of-Care machine. You will also see this occasionally on HEMS. It has its pros and cons. I just thought your service might have been one trying to provide more advanced skills. Thought wrong.

If you are that easily offended by questions, I hope that you will not encounter JCAHO and CLIA inspectors while working in the hospital. They aren't as tolerant or lenient as those you may have encountered while working as a Paramedic with the FD.

1. (bolded) Sorry if you construed an attitude...that's why I put a devil smiley face at the end, I was being a shyte. (if you look at the line that was after where your quote ended...I actually did answer the question. Although prehospital don't draw cultures here, just the most widely used...PT/PTT, CBC, and chem panel, liver maybe)

2. I still work prehospital, and those are the tubes we carry. But my FT job in as a medic in the ED. The only people allowed to do an art-stick at UMC are 2 people...Docs and RT's. The lab doesn't use phlebs to get their blood, they rely on RNs, medics, and PCTs. We are trained on getting blood, but do not have a phleb cert.

3. (underlined) Ya...no one in AZ is THAT progressive! However, as the saying goes...when I'm King of the World....

[VentMedic]

Ya...its another point of lawyers being dumb. From my understanding, the isopropyl alcohol CANNOT be detected when running a BAL, because it is a totally different form of alcohol, and requires a different test to find the level. This being said, the best option is iodine of some sort. The PD test kits that are used here come with them, and when I draw for PD (AZ law says it's ok for PD to get a sample of blood from a PT without a warrant IF there is a draw being done for medical purposes) I use the iodine swab that comes in their kit...I figure it just makes everything a little easier.

The lawyers are actually smart. It wouldn't take much of an expert talking about various machine sensitivites to baffle a jury or create reasonable doubt.

The lawyers also know that each state has statutes which clearly explain the procedure to avoid any reasonable doubt.

Here's an example sited in Ohio:

http://www.sconet.state.oh.us/rod/docs/pdf...07-ohio-350.pdf

{¶3} On February 28, 2006, appellee moved the trial court to suppress evidence of

the alcohol test because the hospital used isopropyl alcohol to cleanse the phlebotomy site

prior to withdrawing the sample in violation of Ohio Adm.Code 3701-53-05(. Upon the

parties' stipulation to the facts, including the hospital's use of alcohol as a skin antiseptic, the

trial court granted appellee's motion to suppress, finding the state unable to demonstrate it

substantially complied with Ohio Adm.Code 3701-53-05(.

Sample protocol:

http://www.chandlerpd.com/gos/G04-phlebotomy.pdf

Article from a police mag. Some of the phlebotomy training standards for PD by far exceed that of EMS.

http://policechiefmagazine.org/magazine/in...;issue_id=92005