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sbmosher
Skewed lab results from PICC and CVCs

Our 300 bed hospital is having an increase in "contaminated" blood specimens drawn from central lines. We have convened a committee to investigate the possible reasons and solutions. The contaminants are mostly IV fluids and meds, especially Heparin. Obviously these contaminated specimens are costly and ultimately cause delays in patient care and treatment. We currently stop all infusions thru all lumens for a minimum of 1 minute and max of 2 minutes, flush the line w/ 10 ml NS and then discard 5 ml prior to drawing the specimen. We draw hub to hub, not thru the cap and we flush with 20 ml of NS following the draw. Does anyone have any advise or thoughts for what might help reduce the occurrence of this problem?

lynncrni
 It is quite possible that

 It is quite possible that your contamination is actually biofilm coming from the catheter lumen. If you are trying to ascertain if the catheter is the cause of a BSI, a blood culture is taken from the CVAD and a peripheral site simulataneously. But if there is some other cause of the BSI under considertion, then I would only draw from a peripheral vein. 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

sbmosher
skewed lab results on specs from PICCs

I was not referring to BSIs. The "contaminants" I was referring to are IV fluids and meds that cause erroneous lab results and require re-testing. Supposedly we are all following the proper procedure for the line draw. I can only guess that despite flush/waste there is residual med or fluid that remains in the lumen and that is why the results are skewed.

jill nolte
Transfers?

 Have you examined your transfer techniques?  For instance, are you cleaning the tops on culture bottles before filling them?  Are you using transfer devices?   How are these handled?

lynncrni
 There are some medications

 There are some medications that adsorb to the intraluminal wall then get aspirated with the sample. But this should only effect serum blood levels of those drugs and there are only a few that have been documented to do this. Have you tracked what lab tests are erroneous? Any pattern? The studies on drawing coagulation tests from any CVAD that has been exposed to any amount of heparin is conflicting with some saying there is no problem and others saying there is. If you can avoid drawing coags from heparinized catheters I would recommend that. Is this primarily from multiple lumen catheters? If so, even though all infusions are stoppped, fluid from one lumen could be aspirated into the lumen being used for drawing the sample. This could be technique related. A large syringe and a rapid forceful withdrawal on the syringe plunger rod could collapse the lumen and cause this aspiration. Vacuum tubes have a high negative pressure which might cause this also. You could switch to smaller syringes, which cause LESS pressure on aspiration. 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

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