Care and Maintenance to Reduce Vascular Access Complications

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Care and Maintenance to Reduce Vascular Access ComplicationsAppendix G: Blood Withdrawal fromCentral Venous Access DevicesBlood WithdrawalMethod of Blood Withdrawal Description Potential ComplicationDiscard■ Removes potentialcontaminate from thecatheter (CVAD)■ Remove a specific amount of blood fromcatheter (CVAD) via syringe or vacutainer■ Use a “new” syringe or vacutainer for theblood sample■ Flush CVAD with 0.9% saline■ Potential nosocomical blood loss■ Potential to confuse a discardsyringe with blood samplesyringePush – Pull■ Requires mixing the bloodback and forth in a syringeseveral times to eliminatecontaminates from thecatheter (CVAD)■ Using a 10 ml syringe, flush catheter(CVAD) with 5 ml 0.9% saline■ Without removing syringe, 6 ml of blood isaspirated, then pushed back into catheter(CVAD)■ Repeat this process x3■ Remove the empty syringe and attach newsyringe/vacutainer to obtain blood sample■ Flush CVAD with 0.9% saline■ May be difficult to obtain enoughblood for 3 – 4 push-pullsequences■ Risk of haemolysis with theagitation of bloodRe-infusion■ Involves returning the discardspecimen after obtainingblood samples■ Aspirate 6 ml of blood into a syringe andcap with a sterile cap■ Obtain blood specimen(s) via a syringe orvacutainer■ Re-infuse the discard from the 1st syringe.■ Potential to re-infuse clot(s)■ Potential to re-infusecontaminated discard■ Potential for error including thepossibility of confusing thediscard syringe with the bloodsample(Cosca et al., 1998; Holmes, 1998)72
Nursing Best Practice GuidelineBlood Withdrawal – Additional ConsiderationsLumenObjectivesAmount of DiscardEquipment■■■■■■■■■■Use the largest Lumen for blood drawsDedicate a lumen for blood draws when CVAD has multiple lumensGenerally not recommended to use heparinized catheter (CVAD) for coagulationstudiesUse of lumens for drug levels if the drug was infused via that lumen:● Does not support the use of silastic catheters for sampling drug levels if the drugis given through the same catheter● Aminoglycoside drug levels should be obtained by standard venicollection (inleukemia patients with indwelling right atrial catheters)● If venipuncture is contraindicated or difficult to perform, the drug level shouldbe obtained from the catheter only after flushing● One method describes to infuse a solution a minimum of 30 min after the doseand then obtain peak levels by standard procedure● Another method is to administer a 10 mL IV push flush with 0.9% NaCI throughthe catheter, which would ensure delivery of the full dose of the aminoglycosideto the patient and then obtain the peak level by standard procedures● Regardless of methods, one should view all drug levels obtained from thesecatheters with skepticism since the system has several possible sources forcontaminationAppropriate amount to ensure accuracy of lab resultsDiscard 3-6 mLConsider dead space volume of CVAD● 2x dead space volume – non coagulation tests● 6x dead space volume – non coagulation testsUse the vacutainer or syringe or a combination of both to obtain blood samplesUse safety engineered devices whenever possible (e.g., transfer devices) to reducethe potential for negative outcomes (e.g., needle stick injury)Smaller syringes exert less negative pressure when withdrawing blood samples fromcatheters (CVAD)(Frey, 2003; INS, 2000; McCall et al., 2003; ONS, 2004)73
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