We have just been told that best practice now dictates that anti x-a's cannot be drawn off central lines. The rationale being that heparin stays in the lumen of the line and skews the results.We have always turned off the heparin for 5 minutes, flushed x 3, drawn the lab and flushed again. Even better if it is a TLC. I have always found that this was "reliable" i.e. the heparin turned up or down and was therapeutic after a couple of labs.I will be researching this on my own but wanted to see if this was 'best practice' where you work.Thoughts?
allnurses Guide Nurse SMS, MSN, RN 2 Articles; 6,838 Posts Specializes in Critical Care; Cardiac; Professional Development. Has 12 years experience. Apr 15, 2015 Yes. Like you, it is a recent change. Patients get pretty upset about it given how often they have to be stuck.
FineAgain 372 Posts Specializes in ED; Med Surg. Has 7 years experience. Apr 15, 2015 Yes! People don't want to be stuck over and over that's why they have a line. Still researching...
MunoRN, RN 8,058 Posts Specializes in Critical Care. Has 10 years experience. Apr 15, 2015 We don't use the same lumen the heparin is infusing through, but there shouldn't be a problem using a different lumen to draw labs from. If the patient is a difficult stick and only has a single lumen CL or PICC then we try to get a peripheral in, run the heparin through the peripheral and draw coags off of the CL or PICC. If all else fails and q 6hr peripheral sticks are problematic then we flush the lumen with 30cc, wait a few minutes and draw.
Not_A_Hat_Person, RN 2,900 Posts Specializes in Geriatrics, Home Health. Has 10 years experience. Apr 15, 2015 What is an anti x-a?
MunoRN, RN 8,058 Posts Specializes in Critical Care. Has 10 years experience. Apr 15, 2015 What is an anti x-a?It's an alternative to an APTT for titrating heparin infusions. Supposedly it can be more accurate, although we tried switching to it at my facility and found it to be unreliable, so went back to ptt's.
blondy2061h, MSN, RN 1 Article; 4,094 Posts Specializes in Oncology. Has 15 years experience. Apr 16, 2015 Interesting, I've only seen anti factor Xa's for LMWH dosing. We exceedingly rarely do heparin drips, but when we do, we titrate on APTT's. We draw them off a different lumen of the CVL. We draw anti factor Xa's off lines too, but obviously not an issue since the LMWH is subq.
