Hello, I have come across a practice where the nurse is drawing labs from the trifuse (manifold) extension set that is connected to the patient's central line. They state that by taking the blood from one of the lumen of the trifuse's, they do not have to disconnect the tubing from the patient's line, that would render it a 24 hour tubing change due to the tubing disconnection. In the case of a blood culture, they change the needleless access device from the trifuse first, then draw the blood. Has anyone else seen this practice of drawing from the trifuse instead of disconnecting the tubing and drawing directly from the patient's line? Thanks!
Several questions about your message. A trifold is a triple lumen extension set but it is not a manifold. A manifold is a series of stopcocks built into the same device. Drawing from the distal end of an extension set is acceptable but there would need to be a greater volume of discard, increasing the risk of hospital acquired anemia.
How many lumens are on the central line you are using. The trifuse extension should only be on one of those lumens leaving usually 2 more lumens for drawing blood directly from the hub. Everything going through the trifuse must be compatibile because everything would meet in that lumen. Hope they are assessing these compatibilities.
Disconnecting the administration set for ANY continuous infusion is never recommended for any reason, but that alone does not alter the change to be a 24 hour set.
Drawing blood cultures from any CVAD is only for the purpose of ruling out the CVAD as the cause of the BSI. If the catheter is not suspected, blood cultures should be done from a peripheral stick. Also drawing blood cultures through additional extension sets and/or stopcocks is never good because they could be the source of the contamination and not the catheter lumen.
The bottom line is this should only be an issue when you only have a single lumen CVAD.
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
Thank you so much for your quick response, Lynn! Yes...it is a mini triple lumen extension set on a single lumen port..sorry about the confusing nomenclature. Most of the patients that I am referring to are pediatric oncology patients with single lumen ports. The Oncologists prefer to draw cultures from the central line. I agree....I think that there is a risk of contamination in using the trifuse for the lab draw. So if we have to draw from the single lumen port with an IV running, it sounds that it is best to disconnect the running IV (mini trifuse and all), and draw directly from the port needle extension set. And not to draw through the mini trifuse. Thank you!
Wow, there is very good evidence that the biofilm growing inside the catheter can easily skew the culture results. False positives and extra treatment would be what you get. You would need to stop all infusions while you draw blood regardless of whether it is being drawn from the port needle hub or the trifuse hub. Peds is at higher risk for wasting blood with the discard method and the trifuse would add volume to the discard volume. This greatly increases risk of hospital acquired anemia and the need for blood transfusion. Sounds like your practice committee needs to take a close look at these practices along with the evidence and write a policy and procedure for it. Standardization thorughout the facility is the goal.
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
Thank you, Lynn. Our Peds Oncologists order line draws from the port, because they intend to treat the organism, whether it is in the peripheral blood and/or in the line, with hopes of maintaining the line. Our staff recognize that line draws are not optimal, so we audit our staff routinely to assure the cleaning and accessing INS standards are met with central line access. I appreciate your input regarding the additional risks with drawing from the trifuse and will share that with our team as we continue with our central line education and audits. Thank you for the information!