central lines

  1. a few of the nurses in our hospital have been having a disagreement on lines and i was hoping to get everyone's point of view.
    some of the nurses feel that it is okay to draw labs from a central line that has tpn, hyperal, or heparin infusing as long as 10cc's are wasted. the other nurses feel that the lab values will be incorrect.
    what is everyone's policy and/or thoughts on this? any comments would be greatly appreciated!!!
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  2. 10 Comments

  3. by   nurs4kids
    We do it all the time with HAL and have for years. We don't even waste 10cc's, we waste 3-5cc's. Never had a problem with abnormal labs! We flush with 3-5 of NS first, then draw up the waste, then the specimen. We even heparinize the waste and give it back most of the time. Works wonderfully and saves our kids from unnecessary sticks!

    We don't do heparin drips, so I'm clueless there.
    Last edit by nurs4kids on Oct 21, '01
  4. by   thisnurse
    we waste 2 fives, draw the labs, then flush with saline, heparin, and saline.
    i asked the lab about this once and they told me the only labs that shouldnt be drawn are blood cultures. they should be drawn from the periphery and the central to see if there is infection in the line.
  5. by   NRSKarenRN
    Last in hospital 10 yrs ago but doing home IV infusion till 3 years ago. Depending on solution: Flush with NSS first, draw up 10 cc if on TPN, otherwise draw up 5 cc for waste. Obtain labs from unused port if possible or use line FARTHEST from Heparin solution if possible. Agree with both above posters.
  6. by   Julie, RN
    If a pt is on TPN we just shut it off, flush it, then wait 5 minutes, then flush it agian and waste at least 10cc's. Now heparin drips depend on the doc and only if they are ording coags is it an issue (PT/INR, aPTT, LMWH,....). Some docs insist on a peripheral sticks away from the infusion, other say just flush really well and waste prior to drawing you lab. Another interesting thing about my hospital is that the lab draws our central line draws, at my last hospital only nurses could do this. But here we do all stat draws.
  7. by   P_RN
    Same here. Most of our Central lines were triple lumen. White port reserved for TPN, Blue for IV fluids and Brown for blood. IN or OUT. Same procedure for PortaCaths.

    Turn off infusion for 2 minutes.

    10 cc NaCl in, 10 cc Blood our & wasted and blood withdrawn for sample.

    Then 10 cc NaCl in and either fluids back on or 3cc Heplok.

    We didn't return the blood wasted as our patients were adults.

    The lab tried telling us that PICC lines couldn't be used for labs. We used the same procedure and I don't recall having any problem.

    Blood cultures were from peripheral sticks if at all possible.

    Check your policy and procedures manual for any specifics your hospital requires.
  8. by   P_RN
    http://www.baxter.com/doctors/iv_the...Basictwo2.html

    Here is Baxter's IV site. They probably know more about IV than I do

    I forgot to say that you need to clamp the line between steps so no air embolus!
  9. by   misti_z
    If I have someone with a line getting TPN, I'll turn off the TPN flush and go draw another pts blood. Then--flush again with 5cc always waste 10cc and withdraw the blood. Our blood cultures are always ordered to be drawn from 2 sites, so we will usually use the line as being from one site. Only the nurse is allowed to use lines
    P_ we do the same with our TLCs as you mentioned.
    Most of our Central lines were triple lumen. White port reserved for TPN, Blue for IV fluids and Brown for blood. IN or OUT.
  10. by   RNPD
    posted by thisnurse "we waste 2 fives, draw the labs, then flush with saline, heparin, and saline. "

    I don't know if this means you use 2 5cc syringes to withdraw blood to be wasted. If it does, why 2 5 ccs? You should always use a 10cc or greater for central lines-the pressure from a smaller syringe is too great & can rupture the catheter. And why disconnect & reconnect twice-adds to infection risk.

    If I misunderstood-I'm sorry!
  11. by   kathy hurley
    Originally posted by shannonRN
    a few of the nurses in our hospital have been having a disagreement on lines and i was hoping to get everyone's point of view.
    some of the nurses feel that it is okay to draw labs from a central line that has tpn, hyperal, or heparin infusing as long as 10cc's are wasted. the other nurses feel that the lab values will be incorrect.
    what is everyone's policy and/or thoughts on this? any comments would be greatly appreciated!!!

    Hi Shannon,
    I'm an RN for New Zealand and this seems to be a universal debate. However it is our policy not to sample of a CVL with either TPN or Hepain running due to the possibility of incorrect lab results. (I'm not sure what hyperal is so I can't comment on that)
    It seems an ideal topic for a research paper doesn't it
  12. by   shannonRN
    thanks for all of the feedback. it is greatly appreciated. i am thinking of talking to the head of nursing research and see if she has any research on this topic or might be interested in conducting her own. thanks again for all of the input!!!

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