Reducing CLABSIs by prohibiting blood draws from line?

[fartjohnson]

In an attempt to reduce our CLABSI rate, my facility has prohibited us from drawing blood for routine blood work from central lines. We are only allowed to do so with an MD order, and the nursing supervisor on duty is supposed to be the one to do it.

Well, I looked around for research supporting this practice (ie: that reducing the number of blood draws from CVCs will reduce CLABSI rate) but I couldn't really find any literature on the matter. The only thing I found was this "project" published in the American Journal of Infection Control:

http://www.ajicjournal.org/article/S0196-6553(11)00471-8/pdf

If you're unable to access the paper, you're not missing much ... here are the last two paragraphs:

Results: CLABSIs rates decreased housewide and central line utilization ratio is trending downward. Caregiverawareness increased along with better outcomes of preserving vital central lines.Lessons Learned: There are rare cases where a patient will be a candidate for a blood draw through a central linedue to physical factors (e.g., no access, emergency, etc.). In addition we identified opportunities to cluster labdraws and reduce unnecessary and/or redundant labs. Since we are also concurrently working on other preventionissues such as education, additional interventions also affected our decreased CLABSI rates. Overall the team feltthat no blood draw from a central line without a physician's order was a huge accomplishment and is possible forthe majority of patients.

In other words, there were too many confounding factors to tell us what role--if any--this particular policy played in the reduction of their CLABSI rate. Terrific.

All of the other research I found about CLABSIs and blood draws dealt with the contamination of blood cultures drawn from CVCs. Certainly an important issue, but not what I was looking for.

Now I can see how drawing blood from a line may increase the risk of infection but I find it a bit curious that seemingly no research exists on the matter. Does anyone else know of any research on this subject? Is anybody else working at a facility that prohibits routine blood work from being drawn from CVCs? I'd love to hear about it.

[KatieMI, BSN, MSN, RN]

Why do we avoid femoral lines? I had a pt with a TLC in the femoral recently so this raised my curiosity.

Because femoral, as well as IJ lines, present independent risk factor for CLABSI according to Joint Commission. It doesn't mean they never should be used, but they shouldn't be the first choice - if there is a choice.

Google : CLABSI toolkit Joint Comission pdf

[MunoRN, RN]

Why do we avoid femoral lines? I had a pt with a TLC in the femoral recently so this raised my curiosity.

Groins are generally less clean than other sites, particularly when you find your femoral site submerged in a lake of diarrhea. Another big reason is that patient's can still be ambulatory with an IJ or subclavian site.

[KelRN215, BSN, RN]

Why do we avoid femoral lines? I had a pt with a TLC in the femoral recently so this raised my curiosity.

We avoid these like the plague in pediatrics, unless there is no other option. Imagine a diapered child with a femoral line. Recipe for disaster.

[MunoRN, RN]

The idea behind prohibiting the use of central lines for blood draws to reduce CLASBI is that each access of the line carries a risk of contamination, whether it's flushing the line, giving a med, or drawing blood. In terms of reducing unnecessary accesses of the line, there are a number of other reasons we access the line that should be higher up the list for being worthy of a practice change before we get to prohibiting blood draws, particularly since there is a real risk of potential harm with delays in lab draws.

[NuGuyNurse2b]

Groins are generally less clean than other sites, particularly when you find your femoral site submerged in a lake of diarrhea. Another big reason is that patient's can still be ambulatory with an IJ or subclavian site.

D'OH! I was overthinking the obvious.