My hospital wants to eliminate drawing coags from any CVC due to the fact that many come back contaminated with heparin and the values are very high. Lab feels that many need to be repeated using a peripheral stick anyways, so to cut costs they want to just forbid drawing them from lines altogether. I feel that it's a nursing education issue and that we should not penalize patients for poor nursing technique.  Some hospitals continue to draw coags from central lines, but do a 20 ml waste beforehand.
How many of you out there have the policy that coags cannot be drawn from a CVC and must be done by peripheral stick? Or if you do draw coags from central lines, what is your protocol? Any info would be really helpful. Thanks!
I am most familiar with a policy that says **not** to use any catheter that has been heparinized for drawing coags. There was an NIH study several years ago that showed a discard volume of 25 mLs is required to get accurate results from a heparinized tunneled catheter. So I do not think this is going to change with nursing education. With this much discard volume, you are wasting far too much blood, even for an adult patient. You run this risk of nosocomial anemia. There is a huge amount of literature published about this in the critical care journals. So I would recommend all coags being obtained from a peripheral stick.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
In the 2 years since this question was asked and answered has anything changed
either as a result of research or published articles related to drawing coag studies from heparinized CVCs?
Robbin George RN VA-BC Vascular Access Resource Department Alexandria Hospital Virginia
Robbin George RN VA-BC
See INS SOP, #57 Phlebotomy, Blood Sampling via A VAD, practice criteria D, page S78 and the 9 references for this statement. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
At my hospital we draw coags from multilumen CVCs provided the lumen the coag is drawn from has not been heparinized. We flush with saline only. If there is a heparin infusion, it is paused for at minimum of two minutes. We don't use a port that has just been accessed for coags. If the patient has been in the hospital more than a couple of days and the port is in use (fluids, meds, other blood draws) we will draw coags from the port. If the port that has been accessed, we won't use it for coags. The "other" lumen practice is not 100% reliable because there is no way of knowing if a heparin infusion has been moved from another lumen. We put a sign over the bed, "heparin to purple lumen only," to encourage consistency.
Nancy Rose