Video coming soon!
In this video, we demonstrate how to place an intravenous catheter and collect baseline blood samples via the IV catheter.
In a true emergency, every second counts. There are a couple shortcuts that you can take to help you complete the most important steps as efficiently as possible
If a patient in a crisis comes through your door, two of your top priorities are to: provide supplemental oxygen and to obtain venous access.
The definition of shock is: inadequate oxygen delivery to this tissues. So providing supplemental oxygen to a patient in shock is a no-brainer.
IV catheter placement is also a crucial step in emergency stabilization. This is your lifeline. Having venous access enables you to efficiently administer some of the most valuable life-saving treatments in the ER: medications, drug reversal agents, vasopressors, intravenous fluids and blood products.
When patients are in shock or near death, accessing the veins can be very challenging and time-consuming. You can actually collect your baseline blood samples via the IV catheter during IV catheter placement to save you time. Combining the two procedures also helps to preserve the patient’s veins, as many of these patients will ultimately require more than one IV catheter to enable multiple treatments to be given simultaneously.
STAT Emergency Blood Tests
It is nice to run a couple quick, easy “point of care tests.” These are some of the most useful parameters to note during an emergency, because they help you to gauge how severe the situation is.
It only takes a few seconds to prepare these samples, and there is usually enough blood in the IV catheter stylet to get these tests started.
Minimally, I always like to run a baseline PCV/TP, lactate (“how sick are you?”) and blood glucose on emergency patients. We have created a separate post where you can learn more about “point of care tests” and their many uses (click here).
If you have that ability to run a very quick STAT emergency panel (with electrolytes, BUN/creatinine), that is great. Checking the potassium level is mandatory in any patient with bradycardia or concern for kidney failure or urinary blockage (click here to read our post on managing urinary blockage in cats). Severe hyperkalemia (>8.0 mmol/L) is life-threatening and needs to be addressed right away; very low potassium levels are pretty easy to fix and can speed patient recovery times.
Checking blood clotting times (PT/PTT or ACT) is also great in any patient with anemia, bleeding or bruising.
Trick for running STAT blood work when you can only get a few drops of blood:
If your patient is almost dead, sometimes you can only get a few drops of blood from a vein. I have actually had several patients that were so close to death when they arrived that even from the jugular vein we could only get a couple drops of very dark (almost black) blood for analysis (in these situations, the jugular is often the only vessel that can be be accessed for IV catheter placement, and even this can be incredibly challenging). Some patients are so small that you are lucky to be get 0.2 ml.
So how can you run an emergency panel when you only have <0.5 ml of blood? In our ER, we have an iSTAT hand-held analyzer (they are very handy and relatively inexpensive, take up very little space and take less than 2 minutes to provide results). If you have a small blood sample, putting the small sample into a blood collection tube is not a good option because it will over-dilute the sample with the anticoagulant. Instead, you can pass your blood sample (even the blood in the stylet of the catheter) through a hematocrit tube to heparinize the sample and then pass this directly into your i-STAT cartridge. (I have to credit an amazing criticalist, Dr. Tim Hackett, with showing me this trick. I have found it incredibly useful, and it has saved many lives.)