Title: Blood Collection – Indwelling Lines
Manual: Procurement & Dispatch / Section: General
Document Number: PROC.GEN.3040 / Issuing Authority: Medical Director, Laboratory Services
Date Issued: December 2003
Purpose
The purpose of this procedure is to ensure patient safety as well as proper technique to ensure collection of a representative sample for testing when appropriately trained individuals access indwelling lines to collect blood specimens.
Scope
Blood collection via indwelling lines is not within scope of practice for laboratory personnel. Blood specimens will only be collected using this technique by regulated health professionals who have undergone the appropriate training as determined by their department protocols. This information is provided as a reference for those named professionals.
Procedure
PICC Line (Peripherally Inserted Central Catheter)
Valved:
1. Turn off all IV solutions for one minute
2. Place sterile 4x4 gauze under injection cap
3. Cleanse injection cap with Chlorhexidine swab
4. Flush with 10 ml normal saline
5. Aspirate gently until blood returns
6. Aspirate 5-10 ml and discard
7. Withdraw blood as required for ordered tests
8. Flush with 10 ml normal saline x2 using the "push pause" turbulent action
9. Resume infusion or if capped, when flushing create positive pressure with the last 0.5ml
Open-Ended:
1. Turn off all IV solutions for one minute
2. Clamp device
3. Place sterile 4x4 gauze under injection cap
4. Cleanse injection cap with Chlorhexidine swab
5. Open clamp
6. Flush with 10 ml normal saline
7. Aspirate gently until blood returns
8. Aspirate 5-10 ml and discard
9. Clamp device
10. Withdraw blood as required for ordered tests
11. Clamp
12. Flush with 10 ml normal saline x2
13. Clamp
14. Resume infusion or if capped, instill 3 ml Heparin 100 U/ml
15. Create positive pressure by clamping with the last 0.5ml
Tunneled Line i.e. Hickman
1. Turn off all IV solutions for one minute
2. Clamp
3. Cleanse injection cap with Chlorhexidine swab
4. Open clamp
5. Flush with 10 ml normal saline
6. Aspirate 5-10 ml and discard
7. Clamp
8. Withdraw blood as required for ordered tests
9. Clamp
10. Flush with 10 ml normal saline
11. Clamp
12. Resume infusion or if capped, instill 3 ml Heparin 100 U/ml
13. Create positive pressure by clamping with the last 0.5ml
Central Line
1. Turn off all IV solutions for one minute
2. Clamp
3. Cleanse injection cap with Chlorhexidine swab
4. Open Clamp
5. Flush with 10 ml normal saline
6. Aspirate 5-10 ml and discard
7. Clamp
8. Withdraw blood as required for ordered tests
9. Clamp
10. Flush with 10 ml normal saline
11. Clamp
12. Resume infusion or if capped, instill 3 ml Heparin 100 U/ml
13. Create positive pressure by clamping with the last 0.5ml
Ports
1. Turn off all IV solutions for one minute
2. Clamp
3. Cleanse injection cap with Chlorhexidine swab
4. Open clamp
5. Flush with 10 ml normal saline
6. Aspirate 5-10 ml and discard
7. Clamp
8. Withdraw blood as required for ordered tests
9. Clamp
10. Flush with 10 ml normal saline
11. Clamp
12. Resume infusion or if capped, instill 3 ml Heparin 100 U/ml
13. Create positive pressure by clamping with the last 0.5ml
Procedural Notes (Summary)
·blood specimens for clinical laboratory testing may be drawn from a vascular access device (VAD) using a blood collection system or a syringe. When doing so, the components of the blood collection system (VAD, connecting device, syringe, needle, and collection device) must be checked to ensure compatibility to avoid air leaks, which may cause hemolysis and incorrect draw volumes.
·Collection of blood through lines that have been previously flushed with heparin should be avoided if at all possible. If it cannot be avoided be sure to follow these steps closely:
-Flush lines with 5 ml of saline to remove all heparin residue which would adversely affect testing.
- Non-coagulated testing - Draw off and discard 2X the dead-space volume of the line.
- Coagulation testing - Draw off and discard the first 5 ml (6 X dead-space volume) of blood prior to collecting the coagulation tube.
· Mix specimens gently but thoroughly as follows
Citrate Tube - 4 Times EDTA Tube - 10 Times
Heparin Tube - 10 Times SST Tube - 5 Times
Red Top Tube - 5 Times Pink Top Tube - 10 Times
.
Safety Precautions & Equipment
BD Biohazard Sharps Containers
Standard Safety Precautions
Contacts
Technical Specialist, Procurement & Dispatch (x 2436)
Related Documents
Venipuncture (PROC.GEN. 3220)
Blood Culture Collection (PROC.GEN.3050)
Specimen Labeling (PROC.GEN.3150)
References
NCCLS H3-A5, Vol 123 No. 32; Dec 2003 “Procedures for the collection of Diagnostic Blood specimens by Venipuncture; Approved standard-Fifth Edition”
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