Infusion Therapy – Central Venous Catheter: Drawing Blood SECTION: 25.05 Strength of Evidence Level: 3 __RN__LPN/LVN__HHA

PURPOSE: TPN is infusing, stop infusion and flush with 20 mL To obtain blood specimens from a central line for normal saline. laboratory tests. 14. Pull back plunger and withdraw 5 mL of blood for discard. Clamp line. (If resistance is felt with flush, CONSIDERATIONS: See Infusion Therapy- Central Venous Catheter: Assessment of Catheter Occlusion.) 1. Confirm physician's order for blood work use of the 15. Discard blood-filled syringe in puncture-proof central venous catheter for drawing the specimens. container. 2. If aspiration of blood or fluid becomes difficult, have 16. Attach collecting syringe, unclamp and withdraw the patient change position, take a deep breath or lift amount of blood necessary for lab tests and one or both arms above head. reclamp. 3. See specific procedures for drawing blood. (See 17. Attach syringe with 10 mL of normal saline to line, Infusion Therapy- Groshong Catheter Maintenance unclamp and flush line vigorously to remove all and Implanted Vascular Access Device (IVAD).) blood from line. Reclamp line. 4. Drawing blood for clotting studies from a 18. General order of sample collections: heparinized line may falsely alter the results a. First: Blood culture tubes or vials. obtained. b. Second: Coagulation tube (e.g., blue-top tubes). EQUIPMENT: c. Third: Serum tube with or without clot activator or gel (e.g., red, gold or speckle-top tubes). Gloves d. Fourth: Heparin tubes (e.g., green-top tubes). Alcohol applicator (wipe/swab/disk/ampule) e. Fifth: EDTA tubes (e.g., lavender-top tubes). f. Sixth (Last): Oxalate/fluoride tubes (e.g., gray- Heparin solution (100 units/mL or as prescribed) top tubes). Normal saline 19. If continuous infusion, attach new pre-filled injection 10-20 mL syringes (2) port, connect infusion with needle or needle less Needles or needle less adaptors (2) adaptor and start infusion. 20. If central line used for intermittent injections, attach Sterile syringes for drawing blood samples pre-filled injection port. Insert needle or needle less Lab tubes adaptor from heparin syringe. Unclamp catheter and Puncture-proof container heparinize as ordered. Before syringe is completely Impervious trash bag empty, clamp line and apply pressure on plunger while withdrawing syringe and needle or needle less PROCEDURE: adaptor. 21. Discard soiled supplies in appropriate containers. 1. Adhere to Standard Precautions. 2. Explain the procedure and purpose to the AFTER CARE: patient/caregiver. 3. Assemble the equipment on a clean surface close to 1. Label specimen with patient's name, date of birth, the patient. time of blood draw. (See Specimens: Obtaining 4. Place patient in comfortable position, making sure and Transporting.) that site is accessible. 2. Document in patient's record: 5. Ensure adequate lighting. a. Date, time, procedure and observations. 6. Draw up normal saline and heparin flushes, as b. Blood samples drawn, identity and location of ordered. laboratory where specimens taken. 7. Open protective package of injection port. c. Amount of normal saline and heparin flush, 8. Insert needle or needle less adaptor straight into including strength of heparin. center of new injection port. d. Type and appearance of venous access site. 9. Slowly inject normal saline flush to fill dead space of e. Patient's response to procedure, side effects injection port and then remove needle or needle and management. less adaptor. f. Instructions given to patient/caregiver. 10. Clean connection of injection port and catheter with g. Communication with physician, if needed. alcohol applicator, using friction. Allow to air dry. REFERENCE: 11. Wrap new alcohol wipe around connection and hold in place until you disconnect injection port or Centers for Disease Control and Prevention (CDC), infusion line. Guidelines for the Prevention of Intravascular Catheter- 12. Clamp line. Remove injection port. Related Infections. 13. Attach 10 mL syringe filled with normal saline to line. Unclamp line and flush with normal saline. If