Looking for information and references as to Lab Draws from CVLs with focus in Pediatrics.
1. How much waste is drawn off?
2. Is the waste returned?
3. What method is used for this procedure? Stopcock?
4. Is there a time frame the waste must be returned? i.e. return waste within 1 minute of of drawing?
5. Is the practice to direct access or draw thru the cap and then change the cap after the labs are drawn?
6. Does your policy state to change the cap after each lab draw and is that the actual practice?Â
7. Is the cap change a "sterile" techniqe with sterile gloves, or prep junction/threads with alcohol and "no-touch?
8. When accessing a Mediport that has been Hep locked with 100 Units/ml, is the waste discarded, returned or the first 2 ml of waste discarded?
9. Does anyone have a weight based lab volume/24 hr maximun allowed to be drawn? Please share.
All may be e-mailed to me @ [email protected]
Thank you in advance for your help.
Moira
The waster or discard blood should never be returned unless you have used a heparinized syringe and a stopcock with that syringe remaining connected to the stopcock while drawing the actual sample. The discard volume is 3 times the priming volume of the catheter. The best resource on technique issues is found in:
1. Frey A. Drawing blood from vascular access devices: Evidence-based practice. Journal of Infusion Nursing. 2003;26(5):285-295.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn,
Our facilities infection control and quality department are looking at eliminating the procedure of drawing blood from all central lines due to our CVC infection rate being above the national benchmark despite extensive staff education on proper care and maintenance of the central line.
Any thoughts on how or where I can start to diffuce this thought or do you think it is a good move?
Kevin
I think it is a great move! I have always taught that all CVCs should not be routinely used for blood sampling. It should be decided based on the needs of the patient. If peripheral veins are available, they should be used. Blood sampling from CVCs increases hub manipulation and hub manipulation increases the risk of CRBSI.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Since I manage the Oncology program as well I worry about those pts that have received chemotherapy where their veins are not the greatest but they have mediports; that is a bit of a comfort issue for them. I understand the reasoning but surely these products can function as more than just infusaports?
I would prefer rigourous education rather than jumping to conclusions that CBSI will occur if we continue to draw blood specimens from them. Sometimes I think we give up too easily to decrease rates based on benchmarks rather than educate on proper techniques. When all else fails, then we should look ay eliminating blood draws but having CBSI rates of 1 or 2 per 1000 cath days doesn't justify this change.
Kevin
October 1, 2008 is coming very fast and that is the date when payment for hospital acquired bloodstream infections comes to a stop from Medicare. Many insurance companies are also follow their lead. I am sure that is what your hospital is considering. The goal now is zero CRBSI. I can understand your concern also about patient comfort but there has to be a way to meet both goals.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Let me know if you find out what that is.................
Kevin