When drawing from indwelling line, adjustments may need to be made if sample is drawn from a heparinized line or blood gases are being collected. The recommended order of blood tube collection is shown in Figure 1.03.įigure 1.03: Recommended order of draw. When drawing blood from an indwelling line, the INR/PTT should be drawn AFTER blood gases to prevent contamination of the PTT from the heparinized blood gas syringe.Īlthough we do not routinely heparinize our hemodynamic circuits anymore, any PTT drawn from a heparinized line should be drawn after at least a 5 ml discard. TPN can significantly contaminate blood samples.Ĭollect Blood Samples to Prevent Dilution or Contamination with IV Fluids or Vaccum Tube Contents If an infusion cannot be safely stopped during blood sampling, an alternative method for blood sampling is recommended.Ĭonsider IV contamination for any patient with unusual electrolyte or lab values. These IVs should be turned off prior to sampling. Infusions from distal peripheral lines or from any other port of a multilumen PICC or temporary venous catheter can dilute or contaminate a lab sample. If IVs cannot be temporarily stopped, the patient should have an arterial line for lab sampling.Peripheral IVs should not be used for blood sampling due to the high risk for hemolysis.A minimum discard sample of 5 ml is required when drawing blood samples from central venous lines due to longer lumen volume.All IVs that are running into any lumen of a multilumen or PICC catheter (including an introducer) must be off for blood sampling (except for blood gases).Assess all IVs that are running distal to the catheter during sampling.Begin with 3-way stopcock positioned with prong toward the sampling port (this is off to sampling port).įigure 1.02: Position of stopcock for withdrawal of blood. Connect vactainer with sampling needle to luer-lock sampling port as shown in Figure 1.01.ģ. Chlorhexidine adheres to provide prolonged gm positive antimicrobial properties.Ģ. The Centre for Disease Control (CDC) recommends 70% alcohol or an or an iodophor for cleansing injection sites. Wait 30 seconds dry time before accessing the port. If no access camp present, scrub the hub for 15 seconds with 70% alcohol and 2% chlorhexidine swab. Press the alarm silence to reduce nuisance alarms during blood sampling.īlood sampling from an arterial line reduces patient discomfort from needle sticks, however, patients should be advised that they may feel a warm sensation in their extremity during line flushing.Assemble vacutainer with access needle, sample tubes and/or blood gas syringe.Note: If you are not collecting any blood into vacuum tubes (i.e, blood gases, glucometer samples or point-of-care testing), a syringe can be used to collect the discard sample and to back flush. One will be used to collect the discard sample and the other will be used to collect backflush. Two additional DISCARD blood collection tubes.Blood collection tubes as required for ordered lab tests.Vacutainer with luer lock adapter and needle.Perform hand hygiene before donning non-sterile gloves. Arterial lines are frequently the source for blood stream infection include central line associated blood stream infections. Back-flushing reduces potential to introduce pathogens. The needleless system reduces the risk for stopcock contamination and needlestick injuries.Ĭollection of backflush solution into a disposable blood tube reduces exposure of health care providers to blood products. Change this cap if if is contaminated or has residual blood. Draw blood sample through the needless access cap. Blood drawing from indwelling arterial or central venous lines is done through a stopcock with a needleless access device on the sampling port.Ĭhange the ethanol Swab Cap(TM) cap after each access. ![]() Check labels with patient's armband at bedside to verify patient, test and label is correct.Order laboratory tests in OneChart and obtain labels and follow steps to closed loop laboratory sample collection.Document reason for enacting a medical directive. Verify there is an order, protocol or medical directive to support the collection of blood.Ensure that patient and health care provider safety standards are met during this procedure including:
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