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Junella heard
drawing blood from central lines, do we need an order to do this?

At this time we are updating polices and want to see if anyone has an evidance that we need  an order to draw blood from central lines,  or is it one of the things we have just always done?  I have tried looking and had no luck. 

Junella Heard CRNI  Picc Coordinator

lynncrni
There are numerous questions
There are numerous questions about drawing blood from any type of CVC but the need for a physician's order is totally dependent upon the hospital policy and procedures. I am in the process of updating my list of articles about blood drawing from CVCs and you can look for a post on my blog by the end of this week. 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

kokotis
All central lines state in

All central lines state in manufacturer instructions that lines can be utilized for blood draws.  These instructions go thru the FDA.   To my knowledge there is no national standard that blood draws cannot be done via central line.  Institutional individual policies may not allow it as in your facility - i.e. MD order.  This is specific to your facility policy.  In general there is no need for a specific MD order to draw blood from a central line.  I suggest you discuss the rational with your institution as to why they do not allow blood draws via central line.  Is it the old wives tale of increased infection risk with no evidence in a study to back up that outdated theory in at least fifteen years.?  Tell your facility to get with the times and back up with proof the rationale for no blood draws via a central line versus we have always done it this way. 

Kathy Kokotis

Bard Access Systems

Kathy Kokotis

Bard Access Systems

lynncrni
Kathy, there is lots of
Kathy, there is lots of evidence that increased hub manipulation increases the risk of CRBSI and using the catheter for blood sampling definitely increases the hub 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

Peter Marino
Lynn, can you post some of

Lynn, can you post some of the articles. I'm woundering if these are retro studies and if they took into account proper swabbing technique equipment type, etc... This stikes a note simular to the increase of CRBSI noted with certain needleless end caps. Which (correct if I'm wrong) was inconclusive or at least not formally studied? I ponder, is it the fault of the operator, the equipment or both? Ultimitly it becomes a question of how can this be changed, nursining technique, equipment design, swabbing solutin, etc....

[quote=lynncrni]there is lots of evidence that increased hub manipulation increases the risk of CRBSI [/quote]

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

lynncrni
At the present time, we have

At the present time, we have studies (yes they may be considered old and most are from Europe) that strongly supports the hub as a major source of contamination that leads to CRBSI. There are newer studies that have documented that biofilm does grow inside many types of needleless systems - these are available on the CDC site, look for articles by Rodney Donlan. 

 Our current state of knowledge about the risk of CRBSI associated with needleless connectors is limited to studies reporting on what has occurred in several institutions. These studies reported a baseline infection rate with Brand X, then changed to Brand Y and documented a dramatic rise in infection rates. Several have returned to the original product and the infection rates dropped.

There are no randomized controlled trials comparing one brand to another with all catheters being cultured. There are no studies on the disinfectant agent or technique that works best for cleaning needleless connectors. The experts are saying that it could be related to the fact that nurses do not properly clean before each use, or to the design of the device. Those with lots of grooves and a fluid pathway that can be easily contaminated **may** have a greater risk, but again no studies have demonstrated this yet. These is lots yet to be learned. 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

Peter Marino
What we need is M-EDTA in

What we need is M-EDTA in 25% ethanol as a lock solution. IMO this will negate the need for many studies. Then extrapolate the data with chloroprep vs neat ISPA and skin flora. Apply that known data to needleless end caps. Am I being too simplistic here?  

Peter Marino BSN

 

 

[quote=lynncrni] The experts are saying that it could be related to the fact that nurses do not properly clean before each use, or to the design of the device. Those with lots of grooves and a fluid pathway that can be easily contaminated **may** have a greater risk, but again no studies have demonstrated this yet. These is lots yet to be learned. Lynn [/quote]

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

lynncrni
There is lots of research

There is lots of research being conducted right now on many different catheter locking solutions. This will require a manufacturer to go through the FDA processes. So we will simply have to wait to see what solution gets to the US market first.

The flush solution is one factor but we must have a greater understanding about the role of needleless connectors in CRBSI. Killing the bugs after they are in the lumen is one approach, but a far better one is preventing them from getting in altogether. 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

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

So Lynn how old are those studies on hub manipulation and increased risk of infection.  I dare say late 80's early 90's.  We base so much of our practice on old studies it is scary.  Who knows what controls, equipment and lines were done back in time.  Probably the old 30 cm acute care lengths to boot with the hub catheter length hanging out.  I no longer trust any study with data that is five years old.  Even new studies like that piece of Maki garbage on CR-BSI/PICC lines being bad had data that was seven years old but was published last year.  BUYER BEWARE is all I can say.  Read carefully.  All is not what it appears to be.

Kathy Kokotis

Bard Access Systems

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