What Vacutainers Do You Carry in your IV Kits?

[Zach Smith]

The services around here usually have us take three vacutainers of blood before running fluids through an IV and I was just curious what types of vacutainers (what colored tops) you use for your service. I've started working on getting my phlebotomy cert so a lot of the stuff we used to not know about and just do is starting to make sense so I'm very curious.

[spenac]

Yellow, Blue, Green, Tiger stripe

[Arizonaffcep]

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.

[VentMedic]

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.

JCAHO and CLIA are two very good reasons.

It is difficult to maintain competency on everyone and it is very easy to make a mistake either by technique or labeling. If there is no quality control monitored for your agency, as with many other things, it would be very easy to make a mistake that could cause harm to the patient if the doctors are relying on accurate information to treat by. Many paramedics don't take the few extra minutes to properly label or identify the specimen. Thus, mislabeling, wrong test and wrong patient errors occur. Nurses have also been fired for assuming too much and doing the labeling for the paramedics.

Believe it or not, it doesn't take much to cause severe consequences to a hospital lab including probation or even suspension of the lab license. We have had hospitals running under contract companies while they attempted to get their lab license back.

[Arizonaffcep]

JCAHO and CLIA are two very good reasons.

It is difficult to maintain competency on everyone and it is very easy to make a mistake either by technique or labeling. If there is no quality control monitored for your agency, as with many other things, it would be very easy to make a mistake that could cause harm to the patient if the doctors are relying on accurate information to treat by. Many paramedics don't take the few extra minutes to properly label or identify the specimen. Thus, mislabeling, wrong test and wrong patient errors occur. Nurses have also been fired for assuming too much and doing the labeling for the paramedics.

Believe it or not, it doesn't take much to cause severe consequences to a hospital lab including probation or even suspension of the lab license. We have had hospitals running under contract companies while they attempted to get their lab license back.

Ok, I can see the whole labeling thing, but not EMS wise...you typically have only 1 patient, and draw blood from them. The blood stays with them in the same room. No real chance for mixing it up that way.

[Just Plain Ruff]

Ok, I can see the whole labeling thing, but not EMS wise...you typically have only 1 patient, and draw blood from them. The blood stays with them in the same room. No real chance for mixing it up that way.

actually, yes there are many chances to mix it up. You go to an ER that has more than one patient in there and the chance of mixing it up is quite real. Are you going to 100% of the time make sure that the blood gets into the hands of the lab tech's or wil you just give the blood tubes to the nurse. If you give it to the nurse then there is one more person to mix it up.

The only way I draw blood on a pre-hospital patient is I will draw the blood, then directly deliver those tubes to the lab tech and watch them label the lab tubes or I will label them myself.

but of course the caveat here is that I have direct access to the lab because I work in the ER. I will take care of the patient after I drop the patient off.

But if you go to a hospital let's say like Baystate Health in Springfield, Mass they get over 100 ambulances a day. There is bound to be a mixup here and there. Trust me, I've seen it happen.

Plus, I'm not sure about clia but if I have to go thru yearly competency for the glucometers I'm sure that Clia has some rules on hospital laboratories taking blood tubes from EMS providers.

[Ridryder 911]

I would like to add that most do not know much about obtaining lab specimens. Many are not aware as well the time allotted for the blood, as well as some has to be drawn first, lightly rotated, placed on ice, etc..

Believe it or not, there is a reason most hospitals do NOT want the baseline labs drawn by medics as pointed out. It was used at one time, but alike anything else experience has proven it not to be beneficial and risky.

R/r 911

[Zach Smith]

Blood samples only have to be inverted 5-6 times and and then can be allowed to sit at room temperature for reasonable periods without any issues. In the hospital the lab will go from room to room drawing samples and they simply label them, place them in their tray, and continue on to the next patient. After making their rounds they return to the lab and deliver them. Our ETA is usually under ten minutes from scene to hospital and the samples are then taken directly to the lab if deemed neccessary.

And thanks for the answers to my original question. Haha.

[spenac]

At my part time service we draw up the 4 tubes mentioned above. Then place in a lab bag that we have placed patient info on. Bag is then taped to IV bag unless we expect to have to change bags.

Now some lab techs do not use our blood draws as they say the 90 mile trip is to long a delay. Other lab techs say no as long as agitated only the tube w/o additive might go bad. Hospital expects us to have a blood draw on any patient that we start a line on.

A problem I have seen is some do not realize that you need to draw blood tubes in a certain order.

[VentMedic]

Expect stricter guidelines since Medicare will no longer pay for hospital mistakes. Hospitals do not want to be responsible for people they have no control over their competency for things that directly affect their lab results where errors can be made.

When you see things happening everywhere in the country that concern skills and education which should be within the area of expertise for EMS (intubation, emergency meds, IV skills etc) failing to monitor acceptable standards, then it is difficult accept responsibility for those in EMS for procedures that hospitals are expected to perform at the highest level. In areas where every FF is a paramedic who try to get their one IV per year in, it is difficult to expect alot. Experienced phlebotomists also know when the blood they are drawing will bring skewed or rejected results just by the way it flows. They won't waste time but will start looking for another site. Some Paramedics in areas where the hospital expects blood to be drawn may just say "blood is blood" and will hand over anything just to make a showing. Then more time is wasted to run bad samples and then redraw.

Some of the other mistakes or issues sited by CLIA include safety. Tube have been broken in the ambulance. Some Paramedics have carried the tubes in their shirt or pants pockets. There was a couple of incidents where a tube rolled away from the pile drawn from one patient only to be found on the next run and turned in with that patient. On one incident it was lucky that the same Lab Technologist was running all the samples and noticed a difference. Unfortunately all of the blood had to be scrapped, thus more time wasted. On the other incident, patient was treated for a low K+ level with adverse results.

If you ever phleb in a hospital, not all samples are treated the same depending on the tests. In some areas of the hospital, it might only be routine AM draws. In the ED, ICUs or specialty units there may be many different types of draws with many different tubes or containers with many different preps. Thus, that is why some areas require phlebotomists to be certified with an entry 150 hour course or 1040 hours OJT with an addition 40 hours of formal classroom.