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Breaking the line to draw blood

This question was asked of our team and I wanted to get some feedback before we respond. Add on devices are also a risk of contamination, disconnection, and misconnection. Please give your feedback on the issue, it seems like more of a risk to me than beaking the line only when you have to for those instances. Thanks!




"I have a question regarding PICC lines and drawing blood. (This question applies when you do not have an open port on the PICC.) I understand that the INS discourages frequently “breaking” IV lines, for example so the patient can ambulate in the hallway or go to PT. But what is their recommendation for frequently “breaking” the line to draw blood? Would placing a stop cock at the distal end of the IV line be an option? I believe what is currently done is the IV line is taken apart “broken” and the line flushed, waste drawn, specimen drawn, line flushed and IV line hooked up again. Is this best practice?"


 The first and most important

 The first and most important aspect is to ONLY use any CVAD for drawing blood when the benefits outweigh the risks. See the Phlebotomy standard in the INS SOP for a list of criteria to assess. In other words, every patient with a CVAD (includes PICCs) requires an individualized assessment. If there are peripehral veins, they must be used for drawing blood samples rather than drawing from the CVAD. 

We have reseaerch supporting the fact that drawing blood cultures through a used needleless connector leads to false positives due to the biofilm growing inside that connector.Therefore it is recommended that these old connectors be removed and discarded BEFORE drawing the sample for culture. This level of study is not available when drawing samples for other lab tests. Also when drawing samples for any test, including culture, it is unknown about whether it is best to draw from the hub-to-hub connection or to place a new connector on the hub and then draw from that. 

Avoiding all CVADs for blood sampling is the best approach, although not realistic for every patient due to extremely poor peripheral veins, or vasovagal reactions from needles or blood. When it can be avoided, it should be avoided and then this technique question is not an issue. If it can't be avoided, the basis for decision making is the least manipulation possible is what should be used, although we don't have a lot of research on specific techniques. Stopcocks should NEVER be used for this purpose as they will only increase the risk of intraluminal contamination and infection. If you must use a CVAD for obtaining a blood sample, and the test is NOT for culture, I would draw from the needleless connector then thoroughly flush the lumen with at least 20 mL of saline following the blood draw. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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