Drawing blood from central lines - page 2
by Altra 14,420 Views | 14 Comments Guide
After several years working in the ER, I am relatively new to critical care. I have a question regarding drawing labs from central lines. Several nurses I work with now like to draw labs in the following manner: attach a... Read More
- 0Feb 9, '12 by MegNeoNurseI work in a PICU and regardless of age or weight, we return the waste when drawing from a CVC, with the acception of heme/onc patients. I found the practice of vigorously scrubbing the hub, instilling 3ml NS, withdrawing 5ml waste, drawing blood needed for lab, returning waste and then flushing with enough NS to clear the line. Never had an issue with contaminated specimen (even if TPN had been running) or hemolysis. As another poster mentioned, clotting is not generally an issue if it is venous and the line draws well. Now if there is heparin or another anti thrombotic running, I would not use that lumen to draw (for obvious reasons folks...)Hope this helps!
- 0Feb 9, '12 by IVRUSAre you disconnecting the waste syringe from the line? If so, that us a very DANGEROUS practice. Also if you remain connected, but hesitate too long before returning the 5 mls of "waste" you run an enormous risk of the specimen clotting. This too should not be reinfused into a pt.
- 0Feb 12, '12 by brainkandy87Maybe my brain isn't working from working all day and night, but I'm not understanding the rationale behind returning the waste when drawing from a central line. To me, the risk far outweighs any possible reward. I mean, is that 10-20 ml of waste going to bottom out their h&h?
- 0Feb 12, '12 by BelgianRNNo not once or twice but if you draw blood every 4 - 6 hours (which is about the standard for nearly all my ICU patients) and do this for 10+ days or even longer. And the patients have increased breakdown of their RBC's due to the critical illness and on top of that generally have decreased manufacturing for the same reason it can become a significant waste if you discard it every time. The effects are still noticeable even if you limit the amount of waste to 5 ml or even less.
But I'm going to try out MegNeoNurse's way of first giving 5 ml of NS to flush the line so hopefully I'll need less waste in that case.
- 0Feb 12, '12 by brainkandy87Ah, good point I guess. I'd still just be so hesitant to return a 20 ml syringe of blood into a pt, even if they were heparinized. I mean, at most I'm wasting 120 ml a day, but in reality you don't need to waste more than 10 ml for a central line, so you're wasting 60 ml/d at most. I'd take the loss over the risk of tossing clotted blood back into a pt. But then again, every situation/pt is different.