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Deb Gnegy
Evidenced based documentaton needed--designating a lumen/port for blood draws

 

For a multilumen catheter, our policy states to use the distal port or manufactures recommendation (usually the largest port),

and then designate the lumen as the blood draw lumen.  

Someone yesterday interpreted "designate a lumen" as the lumen could only be used for blood draws and no other infusions or meds.

I responded that it means use only that port when drawing blood and avoid the other ports.

When asked why a port needs to be designated, I responded with, "it lowers the risk of infection and occlusion".

Our practice policies need to be supported by EBD, so

I've been asked to provide evidence based documentation that supports designating a port of a multilumen catheter for blood draws.

INS standards don't mention designatiing a port (of a multilumen catheter) for blood draws.

lynncrni
When a catheter has

When a catheter has staggered lumen exit ports at the tip, you should be drawing the blood sample from the lumen that is the highest or the one that is above the other lumens. This prevents you from aspirating the fluids that are being infused. When a catheter has nonstaggered lumen exit ports, the largest lumen should be chosen. This information comes from the catheter manufacturers instructions for use. This is your evidence. 

I am nolt aware of anything that says the lumen designation decreases infection and occlusion risk. In fact, there have been discussions on this forum about reducing the blood sampling from catheters because it increases hub manipulation and thus increases the risk of infection. I am not aware of any studies that have included blood sampling as a risk of infection nor any studies stating what you have said. 

The other consideration is what lab test are needed and what meds have been infused. For instance, there are several studies that found skewed coag studies when heparin was also given in that lumen. 

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Deb Gnegy
Thanks Lynn, We only draw

Thanks Lynn,

We only draw from a CVC if the specimen can't be obtained by peripheral stick, and then we need an MD order.  I think our policy says distal because it was the largest lumen on one of our catheters.

Another way to pose the question that is being asked is "What is the harm in drawing blood from one lumen at one instance and then from a different lumen on the next instance.  Does it have to be the same lumen for each blood draw?  Is there another reason (other than choosing the largest lumen or manufacuture's recommended lumen) to designate a port.

Staff's argument is that the largest or most ideal lumen may not be available.

Deb

lynncrni
The other reason is the lab

The other reason is the lab results you need and the drugs that have been infused through that lumen. Taking drug levels from any lumen that has been used to infuse that drug could produce unreliable results. 

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Deb Gnegy
Proximal or distal lumen for blood sampling?

Hi Lynn,

Our policy is up for changes/review.  I re-read your reply (2008) when I realized our policy states to use the proximal CVC port or manufacturer's recommendation for blood sampling and the INS publications state distal lumen.

Of course distal is the tip, proximal, as you describe, is above the other lumens--the lumen closest to the nurse.

Which should it be for short-term multi-lumen SC, IJs, and Fems?  

Thanks, Deb

Deb

lynncrni
The problem with the words

The problem with the words "distal" and "proximal" is they require a fixed reference point. Nurses and many healthcare providers are taught to use the center of the patient as the reference point. Product design engineers use themselves as the point of reference. This means that the actual locations we are referring to with these words is opposite from each other. To a nurse the proximal location would be closest to the center of the patient or the lumen that is coming off of the catheter tip and the distal would be the one that exits higher in the SVC. To an engineer, it is exactly the opposite. Many times, it is the engineers who label these products and write the instructions for use.

For catheters with a staggered lumen exit port, you should be drawing blood from the one that is highest in the SVC. This means that you will be drawing from above all the other infusions, thus reducing the chances of contaminating the sample with the infusing fluid. If the lumens are not staggered (and most are not), you would draw from the largest lumen. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Chris Cavanaugh
Not sure it matters

The manufaturers instructions for use (IFU) should be consulted whenever making a decision regarding care, maintenance or use of any device, including vascular access devices.  As far as devices with multiple lumens and/or staggered end points for those lumens, I am not sure it really matters which lumen you choose to draw blood from.  There are recommendations from professional organizations involved in parenteral nutrition recommend dedicating a lumen for TPN once TPN is started on a patient, but I have never seen any recommendations for dedicating a lumen for anything else.   Since any infusing fluid should be turned off prior to a blood draw, and all lumens exit in the SVC, I am not sure it really matters which lumen is used for blood drawing. 

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

lynncrni
This has changed from past

This has changed from past instructions when Arrow used to recommend drawing from what they called the proximal or longest extension leg, which would be from the lumen exit highest in the SVC above other lumen exits. So are you saying this is no longer in your instructions? Thanks for the clarification, Lynn

Lynn Hadaway, M.Ed., 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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