Blood Sampling from an Arterial Line - Southern Health and Social ...

SOUTHERN HEALTH & SOCIAL CARE TRUSTChildren & Young People’s DirectorateProcedure/Guidelines/Protocol Checklist & Version Control Sheet1 Name of Procedure/Guidelines/Protocol:Procedure for Blood Sampling from an ArterialLine2 Purpose of Procedure/ Guidelines/Protocol:To provide guidance on blood sampling from aperipheral arterial line3 Replaces:4 Applicable to which staff: Neonatal and SCBU nursing and medical staff5 Name & title of author: Una Toland Lead Nurse Neonatal Services andANNP team SH&SCT6 Equality Screened by:N/ANote any issues:7 Proposals for dissemination: Una Toland via team managers to nursing staff8 Proposals for implementation: With immediate effect9 Training Implications: To be included in induction training of all newstaff10 Date Procedure/Guideline/ Protocol 31:03:2013submitted to Procedures Committee:11 Outcome: Approved Comment:Approved/MinoramendmentsNot approvedDeferred12 Date of CYP SMT approvalComments:13 Date of approval by Trust SMT (ifrequired):14 Date approved by HSCB (Social Workonly):15 Date for further review (3 yeardefault):16 Date added to repository:17 Date added to Intranet:State where to be placed on Intranet:

SOUTHERN HEALTH & SOCIAL CARE TRUSTProcedure for Blood Sampling from an Arterial lineStatement:All those involved in the procedure for sampling from an arterial line must betrained and competent in this technique.Standard precautions should be adopted when sampling from an arterial line: ie,non-sterile gloves, and disposable apron.ANTT must be usedStop the procedure and seek medical advice if any of following are noted Resistance is felt The infants displays symptoms of pain Swelling is observed around the entry site Leakage of fluid onto the protective towel Redness around the arterial line site or along the artery Blanching of the limbEquipment:Clean trolleyProtective sheet /paper towelHand held Blood glucose analyser (as blood glucose level is often done at thistime)2 x2ml syringes, 1 x5ml syringesBlood collection bottles as required1 pre heparinised syringe2% clinnell wipe (green)Disposable apron and non -sterile gloves

SOUTHERN HEALTH & SOCIAL CARE TRUSTACTIONDecontaminate hands as per localpolicy adhering to 7 step technique and5 moments of hand hygiene. Put onPPEPrepare trolley for collection of bloodsamples using ANTT and engage anassistant to helpPlace protective paper towel in theappropriate place surrounding thearterial access deviceClean hub of red 3 way tap with Clinellwipe and allow to dry for 30 secondsConnect a 2ml syringeOpen 3 way tap to infant and syringeand off to the baby and withdraw 1 mlof blood.Turn the 3 way tap off to theinfant/infusionRemove the syringeRe-access the device using a 2 or 5 mlsyringeOpen the 3 way tap to the infant andsyringe and off to the babyWithdraw the quantity of blood requiredfor sample analysis. If blood gas isrequired re- access hub attaching thepre heparinised syringe and withdraw0.2mls of blood for blood gas analysis.Throughout the process of removal ofblood observe closely the cannula siteand surrounding area for any redness,swelling, blanching.Turn the 3 way tap off to hub. Open toinfant and infusionRemove the syringe containing theblood sample or samplesRe-attach the syringe containing wasteblood, open the 3 way tap to the infantand slowly infuse.Remove syringe and turn 3 way tap offto the hub.RATIONALETo minimize risk of infectionTo reduce risk of transmission of microorganismsand contamination of sterilefieldTo prevent soiling of cot/incubator bedand unnecessary handling of infant asa resultTo minimise risk of infectionTo facilitate blood samplingThis is waste blood which withdrawsdead spacer, clears the cannula and 3way tap of heparin, old blood and smallemboliTo obtain blood samplesTo minimise blood sampling waste

SOUTHERN HEALTH & SOCIAL CARE TRUSTBefore leaving the infant ensure thatperfusion to arterial site is satisfactory,there is no leakage of fluid from arterialline and the infant is not distressed oruncomfortableDispose of all used equipment as perlocal policyRemove PPE and decontaminatehandsDocument procedure in infants chartnoting blood samples taken and bloodgas analysis result .To detect promptly any complicationsfrom blood sampling and to treatappropriately as soon as possibleTo ensure safety of infant and staffTo prevent cross contamination.To ensure adherence to NMCstandards of record keepingMarch 2013References:www.gosh.nhs.uk/health-professionals/clinical-guidelines/arterial- lines1.Barrington KJ. Umbilical artery catheters: catheter position (CochraneReview). In: The Cochrane Library, Issue 4, 2000: Update Software.2. JoDee Anderson, M.D., Douglas Leonard, M.D., Dana A.V. Braner, M.D., SusannaLai, M.P.H., and Ken Tegtmeyer, M.D.N Engl J Med 2008; 359:e183. O'Gorman CS. Insertion of umbilical arterial and venous catheters. Ir Med. May 2005;98(5):151-. [Medline