Central Line Blood Draw Welcome to the Central Line dressing blood draw refresher. Please use the navigation below to advance to the next page. The Central Line blood draw module is also available as a PDF for printing. Patient Care Standards XIII‐27 Patient Care Standards XIII‐27 1 To obtain a specimen, use the syringe or vacutainer method. th d Syringe Method Sy ge et od Vacutainer Method 2 Vacutainer Method Supplies Vacutainer Method Supplies • • • • • • • • • • Non‐sterile gloves. Al h l Alcohol prep pad. d Luer lock device (blue cap). Normal Saline prefilled syringes. H Heparin prefilled syringe (if heplock). i fill d i (if h l k) EMR specimen labels. Needleless cap if needed. L Luer Lock Vacutainer sleeve L kV i l Vacutainer tubes for blood sample Exception for pediatrics and neonates: use microtainers or neonates: use microtainers or appropriate sized specimen containers. 3 Syringe Method Supplies •Non‐sterile gloves. •Alcohol prep pad •Alcohol prep pad. •Luer lock device (blue cap). •Normal Saline prefilled syringes. •Heparin prefilled syringe (if heplock). •EMR specimen labels. p •Needleless cap if needed. •10 ml sterile syringe •Vacutainer tubes for blood sample •Angel Wing™ transfer dome 4 Wash your hands. Identify the patient and explain the procedure to the patient and/or family member the patient and/or family member. 5 Stop Infusion •If fluid is infusing through a single lumen catheter, stop the infusion. •For multi‐lumen catheter; stop and clamp all other infusions. •Exception: Do not stop vasoactive medication infusions. Consider looking for an alternate blood draw site. 6 Using aseptic technique q Disconnect the tubing from the injection cap. Attach a new luer lock device onto the tubing and set it aside. 7 Scrub the Hub with alcohol pad for 30 seconds (twist back and forth). with alcohol pad for 30 seconds (twist back and forth) Completely air dry 30 seconds. 8 Flush the Line with Normal Saline • • Attach prefilled normal saline syringe into injection cap. Slowly flush saline into catheter Slowly flush saline into catheter using turbulent (push/pause) flushing method. 9 Withdraw Waste • • • After flushing the catheter, withdraw fluid until blood is visualized in the syringe. Slowly withdraw an additional 2ml (minimum waste) and ( ) discard. Exceptions for NICU patients: Withdraw 1‐2 ml of blood if needed, return to patient according to unit procedure. 10 Multi‐specimen draw: Order of Tubes Order of Tubes • • • • • • #1‐ BLUE TOP: contains Sodium Citrate additive. Draw FIRST to p prevent contamination from other additives. This tube is used for coagulation determinations. Invert tube 3‐4 times to prevent clotting #2 ‐ RED TOP: Plastic tube has clot activator. Specimen clots in 60 mins. May be used for serum chemistry & serology assay. 60 mins. May be used for serum chemistry & serology assay. Invert tube 5 times #3 ‐ GOLD TOP: contains NO additive, has clot activator gel for serum separation. Blood clots in 30 minutes. May be used for serum determination in chemistry Invert tube 5 times serum determination in chemistry. Invert tube 5 times #4 – LIGHT (mint) GREEN TOP: contains Lithium Heparin additive & gel for plasma separation. Used for plasma determinations in chemistry. Invert tube 8‐10 times #5 ‐ PURPLE TOP: contains EDTA additive. Other tubes should not be contaminated with this additive for best results. This is primarily used for Hematology & Transfusion services. Invert tube 8‐10 times #6 ‐ GRAY TOP: contains Potassium Oxalate/Sodium Fluoride. Fluoride inhibits glycolysis, used for glucose (for DKA patients) or for Lactic Acid (on ice). Invert tube 8‐10 times 11 If using the Vacutainer method: g •Connect luer lock Vacutainer sleeve onto Vacutainer sleeve onto the injection cap. •Attach Vacutainer tubes and fill with blood. •Follow Follow the order of the order of tubes for multi‐ specimen draw. 12 If using the syringe method: g y g •Attach empty syringe into the injection cap. •Withdrawal blood for the specimen. •Attach syringe to multi‐ transfer dome. •Attach Vacutainer tubes & fill with blood. •Follow the order of the tubes for multi‐specimen p draw. 13 I Invert the Tube h b Invert the Vacutainer tube 5‐6 times for b i f adequate mixing of blood and additive from the tube. Do not shake the specimen tube. tube 14 Label Specimens Label Specimens •Label all specimens tubes at the bedside using 2 patient identifiers. •Mark date & time the specimen was drawn. •Initials in legible block letters. •Place the specimens in a plastic biohazard bag. •Send the specimen to the p lab. 15 Keep the Line Patent Keep the Line Patent Flush the line using a push/pause flushing method. Wash out any infusate or blood from the catheter from the catheter. Repeat if necessary to clear all remaining blood. Maintain positive pressure, clamp the tubing and disconnect the syringe disconnect the syringe. 16 Neonates/Pediatric Patients • For neonates: flush with 1ml of flush with 1ml of normal saline. • For pediatric p patients: if less that 10kg flush with 2‐5ml with 2 5ml of of normal saline. Greater than 10 k fl h i h 5 kg, flush with 5‐ 10 ml of normal saline PCS Policy XIII‐27 17 If locked •Using a push/pause flushing method, slowly flush with 10ml sterile normal saline. 0 l il l li • Then 3ml 100 units/ml heparin flush solution (Standardized Procedure II‐ (Standardized Procedure II 16). •Clamp the catheter extension tubing. Neonatal Patients: Use 1 ml of normal saline then 1 ml of 10units/ml heparin. Pediatric Patients: if less that 10kg, flush with 2‐5 ml NS then 2ml of 10u/ml heparin. Greater than 10 kg, flush with 5‐10 ml of normal saline followed by 2ml of 100u/ml heparin flush. 18 Restart Infusion •For continuous infusions, remove luer lock device from the administration set. •Un‐clamp catheter. •Scrub the hub (30 sec/30 sec) •Attach administration set into the needless cap. •Restart the infusion. 19 Document on the EMR Document on the EMR 20