Central Venous Port Question

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Hi,

I am a nursing student and I was wondering if you could help me. I went to draw blood out a central venous port and I used the nearest one. The RN said to clamp the other port to prevent backflow to that port. Once I did that the RN said to unclamp all the ports to allow the normal saline to go through from the IV.

Isn't it protocol to clamp every port except for the one in use to prevent air embolism or infection to get through? I would think the fluid would get through even if the other ports were clamped. Or maybe not if you were using the farthest port for the IV. I'm confused since I don't see them very often.

It just seems like every nurse does things differently.

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Specializes in Oncology, LTC.

Where was the port? If it has the posi-flow valve on the end of it, NONE of the ports should have been clamped because this would cause back pressure and defeat the purpose of the posi-flow. I don't know if I can help answer your question because all of our ports/central lines at my facility use the posi-flow valves. A lot of nurses incorrectly assume that when not in use, the lines should be clamped when they should not be.

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Specializes in ICU.

Confusing. Double lumen? Triple lumen? Swan-Ganz? If you've got supports running through your other ports, then you -might- not want to stop them, depending upon what they are. TPN? Yes, stop that because that has electrolytes and such that -may- screw up your labs depending on what you're drawing blood for.

Your policy may vary - draw your 'waste', blood sample, return the 'waste', flush with NS. Waste may be 10 to 20cc depending on what else is running in the other ports and may affect your results.

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Specializes in Oncology, LTC.

Yes, it is confusing. The answer all depends and can vary greatly depending on the exact kind of port it is.

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Specializes in ICU.

Here's what you do: find the policy and procedure manual for your unit, read the part on drawing off a central line and verify what you were told. It sounds like the RN you had was doing it correctly, just be careful of what drips you stop. Stopping the wrong ones may come back to bite you depending on the circumstances that you're in. :eek: :lol2:

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Thank you for your answers!

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Specializes in Infusion Nursing, Home Health Infusion.

You should use the term Central Venous Catheter b/c an implanated port is implanted into a vein.artery or body cavity. I wish you knew what kind of CVC you were dealing with. If you have multiple lumens you must shut off ALL infusions through all lumens before drawing any discard and then your specimen. If the patient cannot have the drip or medication shut off for one FULL minute then you will have to find another way to draw the blood.

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Specializes in Vascular Access.
You should use the term Central Venous Catheter b/c an implanated port is implanted into a vein.artery or body cavity. I wish you knew what kind of CVC you were dealing with. If you have multiple lumens you must shut off ALL infusions through all lumens before drawing any discard and then your specimen. If the patient cannot have the drip or medication shut off for one FULL minute then you will have to find another way to draw the blood.

I agree iluvivt, and you MUST stop all medications for one full minute then draw your specimen. Draw the sample peripherally if you cannot stop the infusing medication. Please also note that if you reinfuse, rather than discard the waste, you should only do this if you do NOT detach the syringe. ( It's commonly calling the mixing method, and may be done to prevent iatrogenic anemia, for one reason) I'm hoping that this was what a previous poster was alluding to.

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Specializes in Oncology; medical specialty website.
I agree iluvivt, and you MUST stop all medications for one full minute then draw your specimen. Draw the sample peripherally if you cannot stop the infusing medication. Please also note that if you reinfuse, rather than discard the waste, you should only do this if you do NOT detach the syringe. ( It's commonly calling the mixing method, and may be done to prevent iatrogenic anemia, for one reason) I'm hoping that this was what a previous poster was alluding to.

I'm glad you clarified that. I have never heard of pulling off waste then re-infusing it after you get the specimen. Your exp. makes sense.

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Specializes in ICU.

It all depends on the circumstances. If you're on heavy inotropes and vasopressors, then you *CANNOT* stop anything for a full minute. Otherwise, that will be just enough time to pull the code cart into the room and press the button. Read your policy regarding "waste". When your HCT is 24 or 25 and it's policy to be conserving blood, then you may not have the luxury of tossing out 10cc to 20cc of blood for every lab draw. ;)

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Specializes in Vascular Access.
It all depends on the circumstances. If you're on heavy inotropes and vasopressors, then you *CANNOT* stop anything for a full minute. Otherwise, that will be just enough time to pull the code cart into the room and press the button. Read your policy regarding "waste". When your HCT is 24 or 25 and it's policy to be conserving blood, then you may not have the luxury of tossing out 10cc to 20cc of blood for every lab draw. ;)

Understood, but let's be clear about that waste... One should NEVER disconnect the waste syringe from the patient in attempts to reinfuse it, even in a short time frame. Depending on the patient's coagulation factors, you easily could be reinfusing clotted blood, not to mention the bacterial issues. If however, you remain connected, and use the mixing method, then it is a different story. Are we on the same page here? :confused:

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