Needing some help with blood sampling

[samecat]

I work in an Outpatient Infusion Clinic in a small hospital. We have recently acquired a 7 month old baby with short gut syndrome. He has a central line for TPN and blood draws. When drawing blood, I know that you mix the blood with heparin so you can give the waste back to the patient to decrease the amount of blood loss. What I need to know is how much blood do you draw back and how much heparin to you mix it with? Any help or tips would be appreciated.

Thanks in advance

[outlierrn]

I have done a lot of central line draws but have never heard of mixing it with heparin before replacing it. I would draw at least 5ml for a CBC, 10 ml for chemistry or coags if the line had heparin or TPN in it. Your hospital should have a written policy, but I know they often don't address 7 m/o, so I would contact the primary MD who handles the deep line and TPN orders for clarification

Larry

[mousesn]

I am a nursing student who just did a PICU rotation. We also flushed lines with heparin after drawing blood for labs. Is that what you mean by mixing? We first took out 5cc's of blood, then flushed the line with 2cc's of heparin to keep blood from coagulating in/around the IV.

[NessaNurse]

At the hospital I work at we do a lot of labs via central or pICC for short gut babies as well as otehrs. I usually flush first w 3 ml, draw back 3-5ml for waste, and draw back the very minimum needed for tests. Speak w your lab to see the bare minimum needed. For many labs a microtainer is all you need depending on the lab equipment. I ml for CBC and ! ml for chem 8 (*sometimes 1.5-2 for chem 14, which short guts usually have done). Follow very strict aseptic techinique w the lines on these babies, they are VERY prone to infection

[SKT686]

Our microtainers only require 0.5ml of blood and we get cbc's, complete metabolics, NH4, only a few more specialized, or send out type labs require more.

Have you looked and any of the "closed" systems for drawing from lines?

Sheila:typing

[SmessenBSN]

I work in the PICU and unless the patient has heparin infusing in the line (such as Heparin:NS to transduce ART lines or CVP's) we do not return the waste. We waste (per policy) 10 cc's if we are send coags and 3cc's for all other labs. Draw the minimum amount needed to send the labs off, flush the line and reconnect to whatever is infusing. If the patients hemoglobin is extremely low and we are trying to avoid a transfusion, I will return the waste if it has been less than a minute. Other wise, the risk of pushing a clot back into the patient is not worth it. If nothing is infusing, then we will flush the line with a Heparin Lock flush.

[jillyk*rn]

Hi,

I have NEVER mixed in heparin to give back blood. Is this a policy at your facility? We never give back either, unless it is specifically ordered. Usually only for the Hem-Onc kids.