The revised standards from the Infusion Nurses Society (INS) instruct nurses and IV therapists to perform venipunctures instead of obtaining blood samples from existing lines or during the insertion of short peripheral catheters. The new standard is a dramatic departure from the prior standard, published in 2011, that advocated draws during IV starts and from vascular access devices (VADs).

"This is a huge development," says Center for Phlebotomy Education's Director, Dennis J. Ernst MT(ASCP) NCPT(NCCT). "Drawing during IV insertions was never a good idea, and often created more problems than it solved." Ernst is referring to the frequency of hemolysis when drawing from IV catheters. "Four years ago, the CDC made it a Best Practice perform a venipuncture instead of drawing during an IV start. I'm thrilled the INS has worked it into their standards." Ernst was a member of the CDC's Evidence Review Panel that made the Best Practice recommendation.

Infusion Therapy Standards of Practice cites hemolysis as the main reason venipunctures should be performed instead of draws from IV sets. It specifically states the standard applied regardless of the sampling device attached to the IV catheter. However, it suggests practitioners consider obtaining a blood sample from an indwelling short peripheral catheter for pediatrics, patients with difficult veins or bleeding disorders.

"When we draw blood from an IV catheter, we could be using a medical device for a purpose for which it was not intended," says Ernst. "Not all devices are approved for drawing blood samples. If it's not in the catheter manufacturer's Instructions for Use, it shouldn't be used for that purpose."

 One study showed draws through IV devices hemolyze samples eight times as frequently as when collected by venipuncture.