Blood clots & IV/central line tubing...When does this become a hazard!?

[RN A]

I've been a nurse for 2 years on a medical/surgical unit and have recently transferred to the ICU/CCU. I am currently working with a nurse preceptor for my orientation to the units. My preceptor is great and very knowledgable, but she seems to stress out over everything, both critical and minute. While I draw blood from PIVs/Central lines, she breathes down my neck saying that I need to hurry and that I'm going to slow/will cause a blood clot for the patient. Now, I understand the importance of drawing labs quickly and efficiently followed with a good flush (I've done this skill in my previous position), but my preceptor is the first nurse I've met who freaks out about leaving blood in the line for the few seconds that it takes to fill up your lab tubes with the transfer device. I've done some research online and find absolutely no info about clotting time within an IV line. Can leaving the blood in the IV line for the amount of time it takes to transfer the blood from the syringe to the lab tubes really develop a clot and cause damage to the patient? I feel like I'm going as quickly as I can and she expects me to be flushing my line while simultaneously filling my lab tubes...Is it necessary to be this rushed?

[schnookimz]

If you draw and then put it in the tubes, aren't you letting go of the line?? Then you have to reclean it before you flush?

Why not just draw, flush, and then drop it.

[applesxoranges, BSN, RN]

When we did lab draws from central lines, the lab tech would hand us what we needed such as a flush, then we drew back with the flush syringe for the waste, then they would take the waste and hand us a new syringe. We draw the syringe and pass the syringe to the lab tech who hands us the flush.

[psu_213, BSN, RN]

If you draw and then put it in the tubes, aren't you letting go of the line?? Then you have to reclean it before you flush?

Why not just draw, flush, and then drop it.

Our facility's policy is to "scrub" the hub each time after something is connected/reconnected. I.e., swab, flush, disconnect, swab, draw waste, remove, swab, draw blood, disconnect, swab, etc...

[MunoRN, RN]

In the vascular access world this is considered a no-no. Directly connecting any kind of vaccutainer to a central line is considered sub optimal for several reasons.

It seems to only exist in the vascular access world as a myth that requires frequent de-bunking. Where specifically is this view coming from?

[MunoRN, RN]

Do you know the reason?

We are taught to draw from PICCs using vacutainers. I once had a pt who was an RN working in another state request that I draw her labs using a syringe. I wondered if she was just being paranoid or if there really was a safety issue.

If vacutainer method really is sub-optimal, why is that? Is the reason serious enough to push for a policy change at my facility?

When this issue is dealt with using a systematic decision making process, the result is typically that the use of vacuum collection devices is actually preferable with PICCs.

Manufacturers of PICC lines, who tend to be hyper-cautious about anything that could damage the PICC or cause harm to the patient, include the use of vacuum collection devices in their instruction guide.

[KelRN215, BSN, RN]

If you draw and then put it in the tubes, aren't you letting go of the line?? Then you have to reclean it before you flush?

Why not just draw, flush, and then drop it.

Everywhere I've ever worked, you'd have to reclean whether or not you let go of the line. Policy is to scrub with alcohol for 15 seconds every time you connect or disconnect.

[Asystole RN]

When this issue is dealt with using a systematic decision making process, the result is typically that the use of vacuum collection devices is actually preferable with PICCs.

Manufacturers of PICC lines, who tend to be hyper-cautious about anything that could damage the PICC or cause harm to the patient, include the use of vacuum collection devices in their instruction guide.

Well, quoting what appears to be a capstone project is hardly strong evidence I do concur with the sentiment.

The issues of patient safety relating to evacuated containers tends to reemerge every once in awhile, usually related to large vaccutainers and then extrapolated from there.

Pruitt v. Abbott is a famous tort relating to evacuated containers, resulting in a $850,000 judgement for the plaintiff.

But admittedly, issues are rare and the topic is controversial.

[Melina]

Pruitt v. Abbott is a famous tort relating to evacuated containers, resulting in a $850,000 judgement for the plaintiff.

This case didn't even involve a central line or drawing blood for lab tests, and no medical professionals were found to be culpable.

[MunoRN, RN]

Well, quoting what appears to be a capstone project is hardly strong evidence I do concur with the sentiment.

The issues of patient safety relating to evacuated containers tends to reemerge every once in awhile, usually related to large vaccutainers and then extrapolated from there.

Pruitt v. Abbott is a famous tort relating to evacuated containers, resulting in a $850,000 judgement for the plaintiff.

But admittedly, issues are rare and the topic is controversial.

The Pruitt v Abbott case didn't actually involve vaccum blood collection tubes.

The premise of the case however was that the Nurse failed to follow the manufacturers instructions for use. Use of vacuum blood collection tubes is included in PICC manufacturers instructions for use. If you were using a devices where the manufacturer specifically recommended against using vaccutainers the the case might be relevant.

[la_chica_suerte85, BSN, RN]

Yeah, I also vote for the draw-flush-fill routine as well. Try it with your preceptor and see if the light bulb doesn't turn on for her. I've seen my preceptors leave syringes drawn from an IJ for the phlebotomists to fill for several moments after drawing (this was right after a Dextrose 50% push since the pt was hypoglycemic so why not get the blood, too?) so the phlebotomist didn't have to mess with trying to stick this guy whose BP was in the tank. The phlebotomist appreciated it (I'm sure the pt would have too if he was more with it) and there was no issue with clots.