Submitted by Deb Gnegy, Staff RN, CRNI, WMC, IV Therapy Department on Wed Nov 19 23:23:09 2008
For a multilumen catheter, our policy states to use the distal port or manufactures recommendation (usually the largest port),
and then designate the lumen as the blood draw lumen.
Someone yesterday interpreted "designate a lumen" as the lumen could only be used for blood draws and no other infusions or meds.
I responded that it means use only that port when drawing blood and avoid the other ports.
When asked why a port needs to be designated, I responded with, "it lowers the risk of infection and occlusion".
Our practice policies need to be supported by EBD, so
I've been asked to provide evidence based documentation that supports designating a port of a multilumen catheter for blood draws.
INS standards don't mention designatiing a port (of a multilumen catheter) for blood draws.
Submitted by Deb Gnegy, Staff RN, CRNI, WMC, IV Therapy Department on November 21, 2008 - 09:29.
Thanks Lynn,
We only draw from a CVC if the specimen can't be obtained by peripheral stick, and then we need an MD order. I think our policy says distal because it was the largest lumen on one of our catheters.
Another way to pose the question that is being asked is "What is the harm in drawing blood from one lumen at one instance and then from a different lumen on the next instance. Does it have to be the same lumen for each blood draw? Is there another reason (other than choosing the largest lumen or manufacuture's recommended lumen) to designate a port.
Staff's argument is that the largest or most ideal lumen may not be available.
Submitted by lynncrni, President, Lynn Hadaway Associates, Inc. on November 21, 2008 - 04:21.
When a catheter has staggered lumen exit ports at the tip, you should be drawing the blood sample from the lumen that is the highest or the one that is above the other lumens. This prevents you from aspirating the fluids that are being infused. When a catheter has nonstaggered lumen exit ports, the largest lumen should be chosen. This information comes from the catheter manufacturers instructions for use. This is your evidence.
I am nolt aware of anything that says the lumen designation decreases infection and occlusion risk. In fact, there have been discussions on this forum about reducing the blood sampling from catheters because it increases hub manipulation and thus increases the risk of infection. I am not aware of any studies that have included blood sampling as a risk of infection nor any studies stating what you have said.
The other consideration is what lab test are needed and what meds have been infused. For instance, there are several studies that found skewed coag studies when heparin was also given in that lumen.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
The other reason is the lab results you need and the drugs that have been infused through that lumen. Taking drug levels from any lumen that has been used to infuse that drug could produce unreliable results.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com