Field lab draws by ALS

[ptemt]

For years in FL, we always drew labs and the hospital accepted them. We had the option of doing it or not but if it was a cardiac patient, we had to do it. Yes, it takes a while for troponins to elevate but it was nice to have a baseline right away.

What I don't like is how many of us think you just draw the rainbow in any order. I have asked many co workers and students what order to draw the blood in and they give me that blank stare. Just to test yourself for fun, how many of you know the correct order without looking it up? Don't cheat, admit it if you don't. I didn't for years but then I learned and changed my ways and YES it DOES matter what order they are drawn. Results can be skewed...

In IV class I was taught Red Blood Gives Life to help remember red, blue, green and lavender in that order. I have had a paramedic tell me blue before red. Without looking it up I seem to recall that red is first for measuring clotting factor and that the chemicals in the other tubes could skew results if done before red. I am glad to be corrected!

[Scaramedic]

Here's what I remember..

1. Citrated tube (Blue)

2. Gel/No additive (Red, Tiger, Gold, Mint)

3. Heparinized (Green)

4. EDTA (purple)

5. Fluoride (Grey)

Red can be drawn first since it has no additive, but our coag specialists liked blue first.

Here's a question back at ya AK. Put these specimens outside of the rainbow in the proper order.

Light Yellow (ACD)

Royal blue with both Red & Lavender labels

Blood cultures

Yellow-for AFB cultures

It is probably not fair since I just worked in a Microbiology Lab, but I think ya can do it AK.

Peace,

Marty

:thumbleft:

[mediccjh]

I was told by the service I work for in NJ 2 red, then lavender, pink, blue.

[Ridryder 911]

Each lab or hospital now has its own specific lab "clot" tubes.. so memorizing colors will be futile. I know we have changed colors about 3 times this year alone in hospital. Form light purple to tiger top etc...As other described, drawing in order, is also important and "swirling vs vigorous mixing"...

R/r 911

[CROM]

Our hospital uses our field draws but just for cardiac lab baselines, anything else they throw away.

[buckeyedoc]

There are 2 hospitals that I will draw lab work on pre-hospital. One is a small community ER and I have a wonderful rapport with the ER staff. There are a couple of medics that they will accept our blood draws, but for the most part, they pitch them from others. The other hospital is where I work as a medic in the ER. Our lab will not accept specimens without a lab code. I will draw the samples, put them in a small specimen bag and put my lab code on it in accordance with hospital policies. All blood draws are tracked for errors in labeling and hemolysis. As of now, I have issues with about 2% of my submitted labs.

[Spock]

We don't draw labs any more and in PA medics are not allowed to draw blood for alcohol levels. The PD has to go to the hospital and watch the blood being drawn and labeled. He then takes the blood to the crime lab for testing with a chain of custody followed. Alternatively, the officer can ask the MD to order a toxicology screen and then get a subpoena for the results.

I agree about the color of the tubes. Our lab changes the colors every other week it seems and I always have to ask which color tubes to draw. My hospital (level 1 trauma center) has a policy to DC all prehospital IV's as soon as possible. I just pulled two on a patient this evening. Infection is a real concern.

Live long and prosper.

Spock

[paramedicmike]

The question of infection from prehospital IVs has come up a couple times in this thread.

Are there numbers to support an increased infection rate from prehospital IVs at your hospitals? Or is it simply a perceived threat?

If there are, in fact, increased numbers of infection that can be definitively attributed to field start IVs, is anything being done to address this with local providers in an effort to decrease the numbers? Or is it simply something else for the RNs to bitch about?

It would seem that something as serious as this should be addressed sooner rather than later. I realize that, given the environment in which many of our patients are found, infection is a real concern. But if it's that big a deal that you're seeing legitimate problems I'd be curious to hear what is being done to change infection control methods in the field.

-be safe.

[Spock]

Good points Mike. We have seen infections from prehospital IV's. Is the number greater than that of hospital IV's? Probably not but I couldn't cite exact figures. Pulling prehospital IV's is a hospital policy. The hospital has control over IV's started in house but not over the prehospital IV's. It's not fair but that's the way it is here.

Live long and prosper.

Spock

[JPINFV]

Comparison of clinically significant infection rates among prehospital-versus in-hospital-initiated i.v. lines.

STUDY OBJECTIVE: To compare the risk of infection for i.v. lines placed in the prehospital versus in the in-hospital setting in a midsized emergency medical service system. DESIGN: A retrospective analysis was made of all i.v. line site infections among patients admitted to ward beds from a university hospital emergency department in 1992. METHODS: The hospital's infection control team conducted daily ward rounds and a surveillance of all wound and blood cultures. Patients with signs and/or symptoms consistent with Centers for Disease Control and Prevention guidelines for skin and soft tissue infection were reported to the responsible medical team. Infections were documented based on consensus opinion between the infection control team and the physicians responsible for the care of the patient. IV lines placed in the prehospital phase of care were identified by electronic retrieval from the prehospital database. RESULTS: Three thousand one hundred eighty-five patients who had a prehospital or an in-hospital i.v. line placed were admitted from the ED. Eight hundred fifty-nine i.v. lines were prehospital placed (27%), and 2,326 were in-hospital placed (73%). There was one infection in the prehospital group and four in the in-hospital group (infection rate: .0012 for prehospital patients and .0017 for in-hospital patients; P = .591 by Fisher's exact test). CONCLUSION: Both cohorts had exceptionally low infection rates. No clinically or statistically significant increase in the risk of infection among prehospital- or in-hospital-initiated i.v. lines was identified.

http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Citation