central line blood sampling

Specialties Infusion

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alicecen

13 Posts

Specializes in Infusion, IV, PICC.
Thank you all very much:). Yes the cathater was in the neck :0 My preceptor walked me through it. When I went home I looked it up to refresh my mind with the steps .......not good. I was never shown the policy and precedure (I should have asked). Could you tell me does every floor have one and if you are hired for a job do they usually give you one to study at home.

First- kudos to you and your preceptor that you were at least precepted/ clinically supervised and not asked to do the procedure on your own. From your reply I gather that the policy differed from how you were precepted. Kudos to you again for wanting to ensure you are doing things correctly. To answer your question: In general, the unit you are working on should have access to a nursing policy and procedure for any procedure you are asked to perform. You may not have a current one available to access from home, but there should be a place that you are directed to be able to review P&P (many are computerized), and if you have not done a procedure before- do not be afraid to ask for it.

In practice; there are some small procedures that may not always be covered yet by a policy (not something like a CL catheter removal though!)- if this happens; bring it up with your clinical supervisor and get guided in the correct way to proceed until a policy is in place. I have a feeling that after this experience you will be looking for a policy to guide you from now on.:) Alice

I am not an RN but I am a lab technician. I can tell you that nursing procedures have not kept up with laboratory technology. I just completed testing in my lab that shows as little as 90 microliters of heparin flush per 1mL of patient blood can skew the glucose, chloride, sodium, and especially the potassium in most general chemistries. The potassium was greatly affected. Before changing or making policies about blood sampling from a central line or any line please check with your labs manager or director to check the sensitivity level of their instruments. Never ever draw from the line that a substance is infusing that you want to test for. It does effect the test!!!! You should always throw away the amount of your flush you pushed and the dead space of the lumens. Clamp off all but the line you are pulling from. Stop anything transfusing for no less than 20 minutes before drawing for lab work. If you can't stop the line then don't use the central line for lab testing. Do a venipuncture.

IVRUS, BSN, RN

1,049 Posts

Specializes in Vascular Access.
I am not an RN but I am a lab technician. I can tell you that nursing procedures have not kept up with laboratory technology. I just completed testing in my lab that shows as little as 90 microliters of heparin flush per 1mL of patient blood can skew the glucose, chloride, sodium, and especially the potassium in most general chemistries. The potassium was greatly affected. Before changing or making policies about blood sampling from a central line or any line please check with your labs manager or director to check the sensitivity level of their instruments. Never ever draw from the line that a substance is infusing that you want to test for. It does effect the test!!!! You should always throw away the amount of your flush you pushed and the dead space of the lumens. Clamp off all but the line you are pulling from. Stop anything transfusing for no less than 20 minutes before drawing for lab work. If you can't stop the line then don't use the central line for lab testing. Do a venipuncture.

Dear Lab tech... I appreciate your desire to educate, but I can emphatically tell you that research shows that there is NO reason to turn off medications/solutions for more than one minute.. You may not be aware of anatomy of the central vasculature, but you have a blood flow dumping out of the subclavian into the SVC of over 2000 mls a minute. That is plently of time to rid the body of the contents of a solution/medication.

As far as the heparin flush creating problems, well, I've seen research where it definetely interfers with coag sampling, but not any studies that show it causes problems with electrolytes. Can you publish where you got your information from?

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