I would like to have something in written form that I can give to fellow staff members.  We have many patients with single implanted  Groshong ports.  These ports may have Cardizem drip, PCA. NS, etc. infusing all through the single port.  When lab comes to draw blood what is the correct procedure to obtain sample?  Is turning off I.V.for 2-3 minutes, flushing 10cc ns, wasting 10cc, and obtaining sample the correct way?  I know some nurses want pt. to be a AC stick, but alot of our pt.'s have no veins.  They are uncomfortable drawing blood from port with numerous meds infusing through single port. 

Thanks in advance

Sounds like this would make

Sounds like this would make a great manuscript and something that others need to hear!!

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Practice at my hospital

Practice at my hospital completely supports what Lynn said here.  At one time we "sold" blood draw through central lines as a benefit.  However, we have discovered that there is no substitute for a needle stick lab draw.  In addition to the potentials Lynn mentioned of screwing up your line, you open up all kinds of problems with inaccurate lab results.   I have found that no matter how many times you educate and how specific you get with your policy, there will be lab values that are completely inaccurate from central devices.  Can you do it?  Absolutely, and for a small number of patients it becomes essential but since we have been more discriminate with lab draws from lines, accuracy of labs has increased. 

 

 

Jeff Hanks, CRNI-Vascular Access Nurse, Oaklawn Hospital.  Clinical Consultant, Navilyst Medical (formerly Boston Scientific).

Jeff Hanks, CRNI-Vascular Access Clinical Specialist, Arrow International

Your chances of getting the

Your chances of getting the most accurate lab valves would be from a peripheral vein rather than from a single lumen catheter of any kind with so many types of infusions going through it. I have always believed that blood sampling from any CVC should be reserved for those patients that have a valid reason to use the catheter for this purpose - absolutely no peripheral veins (but this can be very subjective depending on the skill of the nurse) would be one reason. In addition to accurate lab values, you must also consider this increased catheter manipulation will lead to greater risk of contamination, greater risk of biofilm and thus greater risk of bloodstream infection. The other factor in these critically ill patients would be the number of times blood must be wasted which can lead to nosocomial blood loss and iatrogenic anemia. There is lots of critical care information about this. If you do choose to draw from any CVC, there are numerous questions that have not been addressed by solid research yet. With a single lumen that has been adequately flushed with saline, there should be no reason to wait for any period of time. The discard or wasted blood volume should be equal to at least 3 times the internal volume of the entire system. For an implanted port this would include the catheter, port volume, and priming volume of the port needle. I would prefer to eliminate all of these questions and draw from the peripheral vein as well. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861