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Blood draws through infusing central lines

CCU   (12,837 Views | 9 Replies)

misschelei has 8 years experience and specializes in Picu, ICU, Burn.

3,103 Profile Views; 171 Posts

Is it standard practice in adult ICU's to stop a pressor drip, flush the line, draw morning labs, and then turn the drip back on? Flushing the line would bolus the patient then leave them with nothing until the drip started circulating again. In a PICU setting this is a gamble no one in thier right mind would take but I see it happening in adult ICU's at several local community hospitals in my area. Do I just have my Ped's and Adult wires crossed or is this a bad idea no matter who you're doing it to?

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pricklypear has 11 years experience and specializes in Telemetry, ICU, Resource Pool, Dialysis.

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It would depend on the patient. Some patients can tolerate having a pressor interupted briefly, others cannot. If they cannot tolerated having it off, can't draw from the line. As to the bolus, I usually don't flush before I waste, so I don't have that problem.

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669 Posts; 4,599 Profile Views

If it is absolutely necessary to draw off of line running pressors, pause the run, then you first draw BACK about 5-7 cc's of blood off the line to remove drug in there. Then, you draw the blood sample w/o flushing, then flush the line with 10cc's (or more if necessary). The pressor can be restarted at this point.

I will tell you that in my unit (CVICU), we generally have an A-line and draw from that. However, if there is no A-line and we have a very sensitive pt in terms of pressors (we can't pause them for a lumen), then we get to stick 'em. No way around that one.

-Alyssa

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Sherwood has 12 years experience and specializes in Cardiac Critical Care, Trauma, Neuro..

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If it is absolutely necessary to draw off of line running pressors, pause the run, then you first draw BACK about 5-7 cc's of blood off the line to remove drug in there. Then, you draw the blood sample w/o flushing, then flush the line with 10cc's (or more if necessary). The pressor can be restarted at this point.

I will tell you that in my unit (CVICU), we generally have an A-line and draw from that. However, if there is no A-line and we have a very sensitive pt in terms of pressors (we can't pause them for a lumen), then we get to stick 'em. No way around that one.

-Alyssa

I just cannot see it doing any good for your patient to stop an infusion of a vasoactive drip be it dopamine, dobutamine or nipride to draw blood. I think an art line is in order if you are drawing often otherwise they will have to get stuck.

I also think it is taking a risk by drawing blood from a central line. You may clot off the line if you are not quick in flushing it, then your patient will be in real big trouble. This is in addition to the risk of bolusing the patient with a whatever is infusing. Line related sepsis is another issue. Repeatedly drawing blood from a central line greatly increases the chance of introducing a bug into your already compromised patient.

Sherwood

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ZASHAGALKA has 15 years experience as a RN and specializes in Critical Care.

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as a rule, if a patient is so labile that 3-5 min off pressor will cause their pressure to tank (and that's often the case), I wouldn't stop the drip and that patient would be a 'stick' instead of a line draw. Fortunately, most of those patients have art lines that can be drawn from.

And I certainly would never flush a drug-filled line to 'bolus' them in the gap. Not only is that dangerous, very labile patients normally function within a very small and fluctuating line (it's a fine range, but the range changes over time, necessitating a slow increase or decrease in gtt depending on whether they are getting better or worse). A random bolus could disrupt the continuum, taking long minutes or even hours to re-stabilize.

~faith,

Timothy.

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misschelei has 8 years experience and specializes in Picu, ICU, Burn.

171 Posts; 3,103 Profile Views

As I've had a few days to mull this over and read your replies I believe this is a bad idea no matter how you slice it. I almost got into it with the charge RN because I wasn't gonna do it. She even wanted me to stop the TPN instead flush that and draw from there. That made even less sense than the other line. I don't care how much you flush TPN through that line its still gonna screw up your BMP results. The problem is at these small community hospitals the lab does all non-line draws so everyone worries that they will see a central line and complain they had to come stick the patient.

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30 Posts; 1,373 Profile Views

Hm....if patient is on pressors, there is almost always a-line for BP monitoring.

It`s the best way to take blood sample.

Second opinion is CVC lumen without pressors ( with normal saline ). We use CVC with 3 or more lumens and one of them is always for normal saline infusion.

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669 Posts; 4,599 Profile Views

Pt on pressors and blows A-line and it must be dc'd. Pt is now on q1 or 2 min NBP readings for monitoring until new a-line can be reinserted. Meanwhile pt condition dictates (as well as timed labs) that stat blood draws are in order (pvc runs and such).

Pt is extremely edematous. And unstable.

2 ICU nurses cannot get a stick for stat labs. Respiratory cannot find radial artery on either arm. IV nurse arrives (It's the weekend, mind you) and cannot get a stick. Second IV nurse arrives...same outcome. Blood draw is absolutely necessary at this point as per MD on phone.

Guess where we get it from. Our only option...the Swan. Results of the labs showed major problems.

This is probably the only type of scenario (codes don't count) I would consider messing with the pressors. In my unit most are severely labile and if pressors are paused, we just sit and watch the numbers go. I wouldn't recommend it outside of emergency situations. Sticks would most certainly be the way to go.

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CraigBSN02 has 15 years experience and specializes in TNCC CEN CPEN CCRN.

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Is it standard practice in adult ICU's to stop a pressor drip, flush the line, draw morning labs, and then turn the drip back on? Flushing the line would bolus the patient then leave them with nothing until the drip started circulating again. In a PICU setting this is a gamble no one in thier right mind would take but I see it happening in adult ICU's at several local community hospitals in my area. Do I just have my Ped's and Adult wires crossed or is this a bad idea no matter who you're doing it to?

Remember that in triple lumen central lines, each port has its own pathway to the bloodstream (the fluids don't mix). Ergo, if you draw from the proximal port, your chances of contaminating your sample are significantly less and you need not stop the drip.

-Craig

RN, BSN... and others :D

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misschelei has 8 years experience and specializes in Picu, ICU, Burn.

171 Posts; 3,103 Profile Views

You are so right guys but this a small community hospital and a weak excuse for a CCU, so weak that it may have been more appropriate if I posted this on the med-surg icu forum. Alines are not standard and Swans are rare. Most of the central lines are only double lumen PICC's. I just had to know as experts in adult cardiac care if this sounded right to you because it didn't to me.

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