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Caregivers and Blood Draw in the Elderly
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Caregivers and Blood Draw in the Elderly

9060335?1367004010
Unnecessary blood draw and venipuncture remains a significant problem (less so than in previous years) in the super-elderly and very frail with a poor and limited supply of usable veins. If you are a caregiver, or have an elderly relative and an ambulance or hospitalization is necessary, it is worthwhile to provide input in this area (politely). In many jurisdictions paramedics have authority to start what is called a "lifeline" and draw bloods in the pre-hospital environment. Usually they try for the easiest vein, which is the left or right medial antecubital (in the crook of the elbow). What you don't know is that many (but not all) hospitals throw away the blood drawn by the paramedics and remove the line and start another even if the line is perfectly good. The reason provided is "insurance liability". Thus we start another line and waste another vein. There are only so many good veins available. And when they are gone a central line or cut-down is necessary. If there is an actual cardiac event, starting a lifeline in the house is probably a good idea, but many paramedics simply "want to play doctor", and will start a line and draw bloods for a broken arm, stubbed toe, or an eye infection, regardless of whether the patient is twenty years old of a hundred and five. In part this is not their fault. It is due in large degree to the fact that in many jurisdictions their "standing orders" mandate a lifeline. This is where a caregiver comes in. If the patient is elderly and frail, and in your care, there is no cardiac irregularity, or loss of blood, ask the medics "is this line necessary?".  Be persistant, but not obnoxious. When you accompany a patient to the hospital, ask the admitting physician to think about whatever bloods he may need for tests and to take them at one time. Don't yell,  but make a small issue of this. The other issue is they take too much blood, but that cannot be addressed by you. It is possible for the same blood test to be performed using far less blood that is generally drawn. It is not unusual, in my experience, for within the course of an ER visit by an elderly person for four separate blood draws, and then another when they are moved upstairs to a ward. Arghhh!  The patient passes through several specialists and every one wants a special test. Plus, an a teaching hospital students like to have a "full panel" as part of the "teaching experience".
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Avatar_f_tn
I think you answered what I was going to say.  my friend had a permanent needle put in her neck.  she was on chemo and this was better than when I had chemo.  I had to be stuck so many times it ruined about all my veins,  it has been 25 years 26 next month.  cant remember the name od this but they keep it cleaned and all shots and all blood is taken from this one line.  I love this idea.  man876
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144586_tn?1284669764
These are called implanted venous access ports, and there are a variety of them, such as the port-o-cath, providing long-term venous access. They must be implanted and removed under anaesthesia, an exensive in-hospital procedure, and all have a risk from infection. They are used when a patient recieves home treatment or when their veins have been "used up". These "acess ports" represent a great improvement in patient care, but are often recommended simply because the patient's veins have been used up unnecessarily and prematurely. For example, a transfer from one hospital to another (in some hospitals) causes any intravenous line to be removed and a new one started, even if it was emplaced but an hour before. This is allegedly done "for insurance purposes". The introduction of the hep-lock has reduced the number of lost lines, because prior to the hep-lock patients had to be kept on D5W "KVO", which required someone to accompany them certified in IN maintenance. Implanted access ports work well, but should be used only when absolutely necessary.
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Avatar_f_tn
wow I did not know all that.  my friend had cancer surgery when they gave her chemo  she did not have to be stabbed several times.  they kept it cleand out.  my nephew 18 years old had cancer and tthey used ythe same on him they took blood and gave him his ivs with out any problems aagain they kept it cleaned out.  yes they both had to go out patient in the hospital  to have it installed.  when I had cancer it ws just before that I lost all my veins from nurses that did not know how to find the vein.  mandy876
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