Pro’s outweighs Con’s with blood sampling from PIVC

It is estimated that over a billion peripheral intravenous catheters (PIVCs) are inserted worldwide, each year. About 6 of 10 patients have at least one PIVC inserted during their hospital stay ⁽¹⁾. Collection of blood for analysis to set a diagnose, manage medical conditions or to evaluate the effectiveness of an intervention is at least as common, meaning most patients are exposed to multiple needle stick or venepunctures during their hospital stay. Multiple attempts for IV insertion are associated with increasing levels of experienced
pain ^{(2, 3)}. By collecting the blood via the PIVC the number of venepunctures can be reduced and save patients from more bad experiences than necessary.

About 3% of all routine samples are hemolyzed ^{(4, 5)}, collected via direct puncture with steel needle, via PIVC or central IV catheters, meaning it is a common, and big, problem in medical practice. The causes of hemolyzed specimens are multiple. Outside the method for sampling, wet alcohol transfer from the skin to the blood specimen; use of small gauge needles (<21G); difficulty to locate the vein; small or fragile veins; prolonged tourniquet time; unsatisfactory attempts; under-filling of tubes; excessive shaking of specimens; centrifugation and sample transport are causes of hemolyzed blood specimen ^{(6, 7)}.

Collecting blood samples via a PIVC is an everyday procedure, especially in emergency departments ^{(4, 5)}. In other areas of hospitals collecting blood samples via a PIVC is also common, reasons can be difficult venous access, patient comfort or frequent blood samples ⁽⁸⁾.

The risk of hemolysis must be valued when collecting blood samples via a PIVC however 90% of all blood specimens taken by PIVCs have a sufficiently good test result for analysis and save the patient from a second venepuncture ^{(7, 9, 10)}.  Less venepunctures brings benefits such as less pain, anxiety and stress for the patient ^{(2, 3, 7)}. Furthermore, the risk of bleeding and haematomas is minimised, and the risk of infection can be reduced ⁽⁵⁾. On the part of the medical staff, this not only saves time in the execution and disposal, but possibly also reduces stress and risk of needle stick injury. In addition, depending on method and/or facility protocol, it may be possible to make savings in terms of lower material consumption and waste volumes.

• Avoid using tourniquet, as far as possible. If no blood can be withdrawn, apply tourniquet for <1 minute and release immediately when blood begins to flow ⁽⁷⁾.
• If the PIVC is used for fluids or medications prior to the collection of blood, pause any infusion of fluid for at least 2 minutes, flush with saline and discard an appropriate amount of first blood.
• The GBO Holdex tube holder or the SAFELINK holder with male Luer lock have demonstrated to help reduce visible haemolysis in comparison with the standard tube holder ^{(11, 12)}.
• Avoid as far as possible to under-fill the tubes ⁽⁷⁾.
• The risk of hemolyzing blood drawn from IV catheters can be reduced by using 5ml rather than 10ml collection tubes ⁽¹³⁾.
• Avoid excessive shaking of specimens.
• Be careful when transporting the sample.

The potential delay in diagnosis and treatment of the few patients who may need a second venepuncture due to hemolyzed blood should be weight against the potential for delay of care in the many patients who do not require a second venepuncture ⁽¹⁰⁾.

Not all PIVCs include sample blood as an indication for use. When drawing blood via a PIVC, it is important to know if this is included in the instructions for use (IFU), to avoid off label or so-called misuse of the device.

CLiP^® automatic safety IV catheters have blood sampling as an indication for use in its IFU.

To learn more about the procedure of inserting and drawing blood from a CLiP^® automatic safety IV catheter, check out our e-learning opportunities here.

1. Alexandrou et al.: International prevalence of the use of peripheral intravenous catheters: Prevalence of the Use of PIVCs, 2015
2. Fields et al.: Association between multiple iv attempts and perceived pain levels in, 2014
3. Van Loon et al.: Pain upon inserting a peripheral intravenous catheter, 2018
4. Lippi et al.: Critical review and meta-analysis of spurious hemolysis in blood samples collected from intravenous catheters, 2013.
5. Heyer et al.: Effectiveness of practices to reduce blood sample hemolysis in EDs: A laboratory medicine best practices systematic review and meta-analysis, 2012.
6. Coventry et al.: Drawing blood from peripheral intravenous cannula compared with venepuncture: A systematic review and meta-analysis, 2019.
7. Jacob et al.: The impact of blood sampling technique, including the use of peripheral intravenous cannula, on haemolysis rates: A cohort study, 2021
8. Davies et al. Blood sampling through peripheral intravenous cannulas: A look at current practice in Australia. Collegian (2019)
9. Jeong et al.: Comparison of laboratory results between two blood samplings: Venipuncture versus peripheral venous catheter – A systematic review with meta-analysis, 2019.
10. Dietrich: One poke or two: can intravenous catheters provide an acceptable blood sample? A data set presentation, review of previous data sets, and discussion, 2013.
11. Lippi et al.: Reduction of gross hemolysis in catheter-drawn blood using Greiner Holdex tube holder, 2013.
12. Lippi et al.: Blood sample quality using Greiner Bio-One HOLDEX Single-Use Holder and VACUETTE SAFELINK holder with male Luer lock: a comparative study, 2019
13. Cox et al.: Blood Samples Drawn From IV Catheters Have Less Hemolysis When 5-mL (vs 10-mL) Collection Tubes Are Used, 2004.