what is your policy when central line won't allow blood aspiration?

msn2008, MSN, RN · Aug 22, 2006

This just occured at my facility, too. I spoke to several docs and one ordered a stat cxr to verify placement and the other talked about the fibrin sheath. The concensus was if the line is in the proper place and flushes easily, we can use it for meds. The docs attribute the fibrin sheath as the cause for no blood return.

I felt uncomfortable, too, so I'll join the "two-headed" family of nurses!

TinyNurse, RN · Aug 22, 2006

good question. as i know i'll run into it sooner or later as i already do with piccs and portacaths.

jbp0529 · Aug 22, 2006

On my unit, we are not allowed to use a central line unless its been confirmed by xray. Once had an experience with a nurse on my unit who infused a sizeable amount of levophed into a triple lumen that didnt draw blood after insertion, the fluid went into the tissues, and the patient developed tissue necrosis.... wasn't pretty.

RGN1 · Aug 22, 2006

I was taught never to infuse meds unless I can withdraw blood 1st.

jade-athyst · Sep 28, 2006

There is some literature on this. I just took a CVAD class, and got a really good pre-reading packet. It was made up of various different articles found in nursing journals, and it was very helpful. I wish there was some way to get you the whole packet, but if I give you the name of the articles, you should be able to find them on Pub Med or Ebsco .com or something like that. Nursing2002, volume 32, #4, "Getting a Line on Cvad" was vey helpful to me. It mentions a malpractice case where nurses infused drugs through a port-a-cath that had no blood return. The drugs ended up in the tissue causing major tissue necrosis in the pt's breast, that eventually ended up requiring a complete mastectomy. In the class, and in the informational packet, we were told never to infuse drugs in a CVAD unless there's blood return. Having said that, I have only been on my unit since July and have seen experienced, competent nurses do it, more than once. I can tell you one thing, it's not something I'd ever do.

shelq56 · Sep 28, 2006

Thanks for your thoughts. As usual there are nurses who take the time to thoughtfully apply the evidence-based research and those who mindlessly take risks with the lives of patients entrusted to their care. I have studied the literature and also will not use a port that doesn't allow blood aspiration for some of the reasons you mentioned. Thanks again,

Vickie

haji · Sep 28, 2006

This is really interesting to me. I have used many central lines in which one port might draw, but another would. I have always been careful about infiltration of peripheral lines, but I was never as concerned about this issue with piccs, TLC's, etc. Thanks for posting this.

jellenRN · Oct 3, 2006

I am a new graduate and found this interesting since I don't remember ever hearing that you should not use a central line that won't give blood return, although it makes sense. Does that apply if one port gives blood return while the other won't? What about PICC lines? I just had an experience the other day at my new job on a cardiac step down unit with a PICC line that we couldn't get a blood sample from (we got a little blood, not enough for waste etc.) and no one suggested not using it or getting a CXR.

cardiac.cure03 · Oct 5, 2006

Yeah, that was my question...

What if one port gives blood return but the other doesn't?

CVICURN2003 · Oct 16, 2006

Our policy is that all PICC lines and QLC have a PCXR completed and read with a MD order before use. I have freq given meds in a port that don't aspirate blood. Unless of course I have reason to believe that the postion or integrity of the line has been compromised. I will look to see what our official policy is, but have never heard other wise. It is our policy not to draw blood from periph IV's. We also use a cath declotter (the name fails me currently). However, most of our patients recieve a PCXR each morning as the are post CABG or on vents and our pulm order daily chest x rays. I ahve found that the PICC's with the "power Picc" port that the other two lumens are sluggish anyway.

Binkey, BSN · Oct 18, 2006

Any catheter that is centrally placed (tip in SVC) should yield a blood return upon gentle aspiration of the syringe. However, if it is a PICC, that catheter should be a 4 French or greater as the 3 French's inner lumen is such that it doesn't yield a blood return very easily. Remember as well that one should use slow, gentle aspiration of the syringe barrel in order to obtain that return so the catheter doesn't collapse. If a centrally placed catheter won't yield a return try some nursing interventions such as: 1. Have the pt turn his or her head and cough. 2. As long as it isn't contraindicated, have them take a deep breath and hold it. This increase in vascular pressure will sometimes free a catheter as it sucking up the vein wall. 3. Reposition a pt. ie, if they are lying on their side, have them lie on their back. 4. Raise the arm on the side that the catheter is in.

Failure to get a blood return from a central catheter is a real problem.

In the case of a Triple Lumen Catheter, each lumen should yield a return as each on exits into the vascular system at a different spot. When a catheter doesn't yield a return it may have a fibrinous tail or fibrin accumulation covering the exit site of that lumen. This fibrin is a mixture of formed blood elements, immunoglobulins etc. Fibrin development is inevitable, but you don't want it there. You may be able to infuse, but negative aspiration doesn't give you a return. This fibrin is a precurser to bacterial colonization and thrombus.

The lumen that won't yield needs Alteplase (cathflo) to be instilled in it to restore patency.

DD