Lines, tubes, ports, what to do with them ucla cpc. Clamp central line and, if possible, stop infusions while drawing blood. Clinical microbiology procedure manual, asm press, washington, d. Feb 06, 2004 for ptptts we can draw from an arterial line after a waste. Stop any iv fluids infusing through the catheter including another lumen of the. Policies and procedures for infusion nursing 5th ed. It can also be used to measure blood flow hemodynamic monitoring, to draw blood, or for other reasons. Drawing blood from central lines ccu coronary cardiac. Rns carry a medical directive to order cultures when indicated. Since implementing no central line blood draw in october 2014, no participating patient has acquired a clabsi, down from 2. What is your policyprocedure for drawing blood for ptt.
Pediatric central line care seattle cancer care alliance. Other sources that outline blood draw from picc line provide a similar process but more extensive and specific. Central line insertion involves the use of a larger needle 18 gauge versus 21 gauge or 23 gauge for peripheral blood cultures, involves considerable manipulation of the skin and subcutaneous tissues during catheter insertion. A picc line requires careful care and monitoring for complications, including infection and blood clots. If youre considering a picc line, discuss the benefits and risks with your doctor. After identifying the site for the blood draw, gather the appropriate supplies needed. Confirmation of type of central line and line placement must be verified before use until verification is complete, the catheter must be marked with a red unconfirmed catheter sticker pheresis and dialysis catheters will have a specific label attached to the dressing refer to nursing policies and procedures. In addition, the number of times central lines were accessed for specimen collection decreased from an average of 6 to 1. Paediatric and neonatal blood sampling who guidelines on. Indications for blood cultures and central venous catheter cvc insertions often overlap for icu patients. Each blood specimen should be placed into a separate blood culture bottle. There are different types of pressure tubing that different hospitals use.
Depending on the line, the doctor may want your line to get heparin, an anticoagulant, to prevent the line from clotting off. A long catheter may be advanced into the central circulation from the antecubital veins as well. It is used to give your child fluid, nutrients, medicine, and blood products. The choice of site and procedure venous site, fingerprick or heelprick also referred to as capillary sampling or skin puncture will depend on the volume of blood needed for the procedure and the type of laboratory test to be done. Using pushpause flushing method, slowly flush saline into the catheter. Picc line blood draw explained e phlebotomy training. Central lines are ivs which allow medications to be given into large veins in the body, or to draw blood for lab work. Picc blood draw procedure choose a port to draw blood.
Change this cap if if is contaminated or has residual blood. Central venous catheters picc, short term, tunneled, i. I wore a surgical cap, mask with protective eyewear, full gown and sterile gloves throughout the. Granted, few central lines are accessed by radiology and rarely by doctors, but the bottom line is that nurses are the ones inserting, maintaining, and removing the lines. Connect the ends of the blood lines to the catheter aseptically. Using evidencebased practice to reduce central line. Registered users can save articles, searches, and manage email alerts. Attach sterile syringe, unclamp the catheter, withdraw blood, and flush per facility protocol. For ptptts we can draw from an arterial line after a waste. What is central line in medicine, a central venous catheter central line, cvc, central venous line or central venous access catheter is a intravenous device that is inserted into a vein in the neck internal jugular vein, chest subclavian vein or axillary vein or groin femoral vein. I was under the impression that you always have to do a waste before collecting any specimen from a central line access but a traveling rn related that she was told to draw no waste when collecting from a central line for blood cultures. I need to know the proper procedure for administering medications and drawing blood from a central line, and the proper flushing procedure and maintence of a central line. Jul 02, 2015 this video shows how to take a blood culture from a central line, when there is suspicion of line related infection. Consider a twoperson technique to permit one person to draw and flush the central line and one person to transfer the specimen.
A central venous catheter cvc, also known as a central line, central venous line, or central venous access catheter, is a catheter placed into a large vein. Nov, 20 central lines are ivs which allow medications to be given into large veins in the body, or to draw blood for lab work. My hospital does not have the small needleless port for blood. Remove alcoholimpregnated cap or scrub the hub with alcohol for 15 seconds. This chapter covers all the steps recommended for safe phlebotomy and reiterates the accepted principles for blood drawing and blood collection. It is important for the phlebotomist to follow a stepbystep procedure to ensure consistency and to make the patient comfortable. The information given in this section underpins that given in the remainder of part. The video below shows how to draw off of an arterial line. Blood samples drawn from iv catheters have less hemolysis when 5. Apr 18, 2016 in addition to continuous blood pressure monitoring, arterial lines are also quite useful in telling acidbase balance and oxygenation levels. If unable to obtain a blood waste, may use a sterile 12ml syringe or a vacutainer transfer set.
The chapter includes background information section 2. Jan 12, 2010 i have a question regarding drawing labs from central lines. Keeping the syringe attached to the catheter hub, push to reinfuse the. Uncap iv tubing, reconnect to central line, and resume any iv infusions. Any other central line or peripheral iv it is not policy to draw from. Such procedures should clearly state the risks to patients and health workers.
The effect of blood drawing techniques and equipment on the hemolysis of ed laboratory blood samples. Step by step procedure for how a phlebotomist draws blood. Two distinct situations place patients at a risk of acquiring a clabsi. If you are a patient reading this that is nervous about having blood work done, read through the following and look at the pictures supplied. To obtain blood specimens from a central line for laboratory tests. Always refer to the policies and procedures site for the most current versions of documents in effect. Some of these include vasopressor infusions, longterm medication or fluids, chemotherapy, longterm nutrition, repeated blood draws, and dialysis. Blood drawing from indwelling arterial or central venous lines is done through a stopcock with a. This chapter covers all the steps recommended for safe phlebotomy and reiterates the accepted principles for blood drawing and blood collection 31. Instructions for how to draw blood from a central line aseptically. When compared to a typical iv line, a central line is larger, can stay in place longer, can deliver a greater volume of fluids and allows blood to be drawn easily. Several nurses i work with now like to draw labs in the following manner. Rt and or rn are capable of drawing a blood gas from an arterial line.
Raad et al evaluated 404 cases of candidemia in patients with cancer and cvcs and found that catheter removal within 72 hours from the first positive blood culture was necessary for patients with central line associated candidemia, but did not change the outcome when the candidemia was not associated with a central line. Obtain a needleless blood transfer device to draw blood. Blood drawing from indwelling arterial or central venous lines is done through a stopcock with a needleless access device on the sampling port. A central venous catheter cvc is inserted by a practitioner for a variety of reasons. A rolling central line cart was assembled with only evidencebased supplies and was brought to the bedside with each central line insertion. Procedure for taking blood from a central venous catheter links to. Patients are usually nervous if theyve never had it done before, or sometimes they have a phobia of needles or doctors offices. Indicate central line draw by color for multilumen tunneled catheters and by side of port for multilumen implanted ports or peripheral line. Established plan of care the plan of care for blood withdrawal from a picc may be considered established when the patients picc has been previously accessed for blood withdrawal, and is known to be patent and uncomplicated. Central line infections can present as blood stream infection andor local phlebitis. Procedure for taking blood from a central venous catheter. A venous access device whose tip dwells in the superior or inferior vena cava. Consider a twoperson technique to permit one person to draw and flush the central line.
Bear in mind that when you do so, you increase the risk of cvcrelated complications, such as occlusion and infection. The line can deliver medicine or nutrition right into your bloodstream. Label specimen and requisition with line draw sticker. Understanding the rationale of not drawing regular blood cultures through the central line, based on our blood culture procedure for adult patients cm b. Jan 07, 2012 a timeout was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. Groshong, groshong n xt picc and midline perqcath, poly perqcath picc and midline blood withdrawal needle to needless adapter through injection cap vacuum blood collection system or syringe 1. Code 36592 blood from a peripherally inserted central catheter picc line has a status indicator n, which means that if the physician performs these services with any other service on the same day and charges those services, cms will package them. A central line is a type of catheter that is placed in a large vein that allows multiple iv fluids to be given and blood to be drawn. Central venous catheter hub cleaning prior to accessing. Aug 31, 2017 a central venous catheter cvc is inserted by a practitioner for a variety of reasons. Instead they give the following process as the one to follow when drawing blood from a picc line cdc, 2011. Institutions can use these guidelines to establish standard operating procedures. Pull back plunger and withdraw 5 ml of blood for discard. Collect a second blood culture by using the peripheral draw technique.
If the central line is the source of blood stream infection, i. Per our policy we can draw from aline but cant do any other blood draws through central linestriple lumens, cordis, piccs, etc. Using picc lines to draw blood is a common practice in the medical unit where i work. It is also used to get blood samples without having to draw blood from your childs arm. The hospital where i work has no policy on this topic and i learned in nursing school that drawing blood from a picc line was not appropriate because of the increased risk of developing blood clots. In addition to continuous blood pressure monitoring, arterial lines are also quite useful in telling acidbase balance and oxygenation levels. If tpn is infusing, stop infusion and flush with 20 ml normal saline.
Obtaining blood cultures under the strict sterile precautions utilized for cvc insertion might be. Specimen collection procedure blood cultures, line draws. The procedure can be hindered by flinching and tenseness caused by either the patient or phlebotomy technician. If you only have enough blood for one bottle, place the specimen in the aerobic yellow or green bottle. Sep 05, 20 drawing blood, while routine, is a learned skill. A picc line is one type of catheter used to access the large veins in your chest central venous catheter. Nov 26, 2016 granted, few central lines are accessed by radiology and rarely by doctors, but the bottom line is that nurses are the ones inserting, maintaining, and removing the lines. A central line is often used instead of a standard iv intravenous line when you need treatment for longer than a week or so.
Flushing a central line requires saline flushes and alcohol pads. If blood return cannot be obtained from a central venous line, refer to the central venous line occlusion management and declotting procedure cen05. If necessary, clamp the catheter when flushing is complete. Shr accepts no responsibility for use of this material by any person or organization not ass ociated with shr. She stated that in drawing the waste, you have less of a possibility of obtaining any problem from the line. Saskatoon health region shr cannot guarantee the currency or accuracy of any printed policy. If you have high dose vasopressors running, use your best discretion about whether or not to turn them off. Remove and discard the used syringe and attach a new. Evidencebased practice for obtaining blood specimens from a. My hands were washed immediately prior to the procedure. Arm with picc line arm with a preexisting or current blood clot. Some sources express the view that drawing blood from central lines is not ideal, as the additional manipulation of the hub and the possibility of blood adhering to the inner. Attach one of your saline flushes to the port and flush your. Drawing a blood sample from a patient is the main job for a phlebotomy technician.
Chapter 4 also provides information relevant to the procedure for drawing blood given below in section 2. Change the ethanol swab cap tm cap after each access. Why a central line is necessary and associated risks. Central venous access devices can be used to avoid repeated venipunctures for patients who need frequent drawing of blood samples. The patient was placed in a dependent position appropriate for central line placement based on the vein to be cannulated. Draw up 10 cc normal saline in syringe and set aside 0. Confirm physicians order for blood work use of the central venous catheter for drawing the specimens. Repeat for other limb this might occur in parallel. If resistance is felt with flush, see infusion therapy central venous catheter. Significant differences exist, however, in the process of drawing blood between central and peripheral blood cultures. Repeat the aspiration and reinfusion at least three times. Internal jugular central line procedure note ventura family med. With over 1,700 procedures and skills from a wide variety of nursing specialties including allied health, it combines the most trusted clinical content with powerful online workflow functionality that will enable your clinical staff to save time, standardize care and deliver.
May 24, 2017 since implementing no central line blood draw in october 2014, no participating patient has acquired a clabsi, down from 2. Through injection cap technique preferred for clabsi prevention 1. Nov 19, 2010 central venous line placement is typically performed at four sites in the body. Disinfecting the ends of the blood lines is not required if the blood lines have been handled aseptically prior to connection. General information for central venous catheters including slic d.
Any order for blood cultures should consist of a minimum of 2 complete sets of cultures. Blood cultures at central line insertion in the intensive. A central venous catheter, or central line, is a small flexible tube inserted into a large vein in your childs chest. Indications arterial blood gas values may be indicated before and after the start or. Alternatives include the external jugular and femoral veins. Physicians orders sampling will be done at the physicians order or as per the specific icu protocol. Summary of ahc approved processes to prevent central line infection c. What is your policyprocedure for drawing blood for ptt from. Understand status indicators for codes 36591 and 36592. Peripherally inserted central catheter picc line mayo clinic. Flushing and blood withdrawal from a central line youtube. While generally not placed solely for drawing blood, a central venous access device.
Blood and blood products antibiotics medicationsolutions in patients with limited peripheral access therapy that is ongoing or continued at home are also useful when frequent blood tests are required, reducing the need for repeated venipuncture. Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. Central line insertion and how to draw blood from new to icu. Malpositioned catheters catheter should not be used as a central vad until it is repositioned and tip is confirmed to be in a central location interventions for piccs. The patients was prepped and draped in sterile fashion. Lippincott procedures is your online source for instant, evidencebased procedure guidance at the point of care. A central venous access device inserted into a peripheral vein whose tip dwells in the superior vena cava and is used in acute care, long term care or home care. Central venous catheters picc, short term, tunneled. Using the same syringe, pull to aspirate 6 ml of blood into the syringe. Each set of cultures should be drawn from a different draw e.
Central line central venous access device saint lukes. Except in the case of coagulation studies, in which case the discard is 6 x the dead space volume 6 ml minimum. Nursing schools do not teach this skill due to legality issues. Is it appropriate to draw blood for lab work from picc lines. Increased risk of central line associated blood stream infection clabsi increased risk of catheter occlusion. Policy and procedure flushing and or blood withdrawal. The type of cvc inserted depends on the emergency and necessity of the iv line.
Although the safest and most accurate way to draw blood for lab work is via peripheral veins, you may need to draw blood through a central venous catheter cvc if the patients peripheral veins are no longer accessible. Reducing the risk of central lineassociated bloodstream. I need info for my clinical objectives and i have searched every where for the correct information. Without proper specimens, unhelpful or even harmful medical treatment could happen. While healthcare providers are trained in caring for this type of device. Nurses, residents, and attending physicians were educated about the importance of the process changes.
Flush the picc line with a 10 to 20ml normal saline. Groshong and groshong n xt picc and midline blood withdrawal hub to hub perqcath picc and midline blood withdrawal 1. The centers for disease control and prevention cdc does not state that it is inappropriate to draw blood from a picc line. Best practices in phlebotomy who guidelines on drawing. Placement of larger catheters in more centrally located veins is often needed in critically ill patients, or in those requiring prolonged intravenous. Draw one set through device and one set from a separate venipuncture for routine blood culture top of page. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. Differential period of central line culture versus peripheral blood culture positivity 2 hours. Lock the prefilled normal saline syringe to the port using a luer adaptor.