We have a policy that we stop all infuions that are not titrated medications for 1 minuite prior to drawing a discard and labs from a central line. I now read in a phlebotomy book that infusions should be on hold for 3 minutes. How long do other institutions put their lines on hold prior to draws?
I am not aware of any evidence to support a specific length of time. What is the reference used in this textbook for 3 minutes? If they have no reference, then I would infer that it is a professional opinion and not an evidence-based recommendation. I would worry about blood reflux and the beginning of partial obstruction with the 3 minutes. Of course, the overall practice now is to avoid use of all CVADs for blood sampling due to the increased risk of contamination from the excessive manipulation 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
Lynn, to not use the CVAD's for sampling makes sense to prevent CLABSI. Could you please give the studies supporting this? I'd like to present it to my facility for consideration. Thanks
First is a new set of guidelines from Joint Commission. News Details | Joint Commission
Second is the INS standards of practice on phlebotomy, which calls for a patient specific assessment of the risk vs benefits of using a CVC for this purpose.
Third is Contamination rates of blood cultures obtained by dedic... [JAMA. 2003] - PubMed - NCBI
For a CVC, this is based on our knowledge of hub manipulation increaseing the risk of intraluminal contamination, biofilm growth, and BSI. So the thought is to decrease the BSI rates by decreasing hub manipulation to as little as possible.
Unfortunately, I am not aware of a specific clinical study that directly compares infection rates in CVC used for blood sampling and those not used for this purpose.
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