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A clinical inquiry team was formed and included the pediatric direct care nurse, an infusion nurse specialist, medical laboratory scientist, nurse researcher, academic faculty partner, and pediatric nurse educator. Doctorally prepared team members provided mentoring of the direct care nurse in research processes. The research study proposal and protocol were designed collaboratively by the team and approved by the hospital’s Institutional Review Board, with the direct care nurse leader as a co-investigator. The purposes of the study were to (a) compare quality outcomes from two methods of blood sampling, specifically drawing blood per venipuncture and per pre-existing peripheral infusing intravenous (IV) access, and (b) provide a model of direct care nurse leadership in an original research study.
Methods: The design of the study was correlational. The sample consisted of patients on one pediatric unit in one Midwestern teaching hospital who were between 6 months and 17 years of age. Parental consent and participant assent for children 7 years of age and older were required. Per study protocol, two blood samples were drawn, one blood sample per venipuncture and one blood sample from an existing infusing IV. The two blood samples were compared for accuracy through tests of hemoglobin, glucose and potassium. The protocol prescribed the sequence and timing for pausing and flushing the existing IV. In addition, patients or family members scored patient satisfaction and patient distress for both methods on 1-10-point visual analog scales and stated their preference of methods. Rates of hemolysis and IV occlusion were recorded. The pediatric direct care nurse enrolled 95 patients with complete data sets. The response rate was approximately 66%.
Results: The convenience sample (n = 95) was 52% female and averaged eight years of age. Potassium and glucose levels were not statistically significantly different between the two blood draw methods. Hemoglobin levels were significantly different (p < .001). A case-by-case review of the hemoglobin values was conducted by a team that included an experienced pathologist, statistician, and medical laboratory scientist. The statistically significant variance in hemoglobin levels was within the acceptable margin of error set by the College of American Pathologists and was not deemed clinically significant. Patient satisfaction was higher and patient distress was lower with the IV method (p < .001, p < .001, respectively). Samples drawn per IVs were more likely to hemolyze than were the samples from venipuncture, per laboratory reports (p < .002). However, the frequency of hemolyzed samples was not beyond the usual expected rate per national standards. Younger participants reported higher distress with the venipuncture method than older participants (p < .05). No IVs occluded. Participants (99%) overwhelmingly preferred the IV method of blood sampling.
Conclusions: The results indicate that blood samples can be drawn accurately and safely from existing infusing peripheral IVs in hospitalized pediatric patients, as compared to blood samples drawn by venipuncture. Hemoglobin, potassium and glucose levels across the two sampling methods were similar. There was no clinically significant evidence of hemolysis or IV occlusions when blood samples were drawn from IVs. Participants strongly preferred the IV method.
Implications: Pediatric nurses can pilot procedures to draw blood samples from existing infusing peripheral IVs in hospitalized children, giving careful attention to the pausing and flushing of the IV and the monitoring of quality outcomes. Recommendations are that this study be modified and conducted as a randomized control trial, with each participant assigned randomly to a blood sampling group, rather than all participants experiencing both methods of blood sampling. This study provides a model for direct care nurse leadership in clinical inquiry within the structure and processes of a shared governance system.