This can not be done because the catheter hub is not sterile. Neither is the needleless connector or the attached tubing. So no, I have never heard of such a procedure. Lynn
I have not heard of a sterile procedure for lab draws via a CVAD as well but I also have a question regarding blood sampling via a CVAD and would like some clarification.
I have a question regarding which lumen is the recommended lumen fro blood sampling in a mult-lumen catheter. Specifially a staggered TLC, I am under the understanding that the distal lumen is closer to the RA in the SVC and the proximal is further away from RA in the SVC is mu understanding correct? I was also told and have seen in numerous references to use the proximal lumen for lab draws. The INS "Infusion Nursing an evidenced-based approach 3rd edition" states the preferred lumen in the distal lumen. I just need clarification in regards to #1- is my understanding of the lumens in correct? #2- which is the most optimal lumen for blood sampling. I was under the impression that the proximal is recommended when medications infusing in the other lumens cannot be paused during the lab draw, therefore no reflux of medications can occur when infusing in the other distal lumens. I would really appreciate the clarification because the recommendations are varying and I am not clear on why.
The reason why there is confusion about the recommended lumen for drawing blood samples on staggered lumen exit catheters is the misunderstandings about the words distal and proximal. These words require a reference point. For nurses, that reference point is the center of the patient. For engineers designing the catheter, the reference point is themselves. This means that the word distal will be opposite ends of the catheter to these groups of professionals. For a nurse, the distal exit lumen is the highest on the catheter or fartherest away from the catheter tip because the center of the patient is the point of reference. For a nurse the proximal lumen is the one at the tip of the catheter. But these catheters are labeled opposite this way. The distal lumen is the one at the catheter tip because it is the fartherest away from the engineer who designed. The proximal lumen is the one closest to the engineer or the lumen exit highest on the catheter. So when you have a catheter with a staggered lumen exit, you should drawn from the exit that is highest on the catheter, the one fartherest away from the catheter tip. This is based on the idea that drawing from above all infusions will limit the amount of infusing fluids that can get into the blood sample. This does not totally prevent infusing fluids from getting into the blood sample but it would reduce the change. Hope this clears up this problem. I try to avoid use of these words because of this problem. Lynn
This can not be done because the catheter hub is not sterile. Neither is the needleless connector or the attached tubing. So no, I have never heard of such a procedure. Lynn
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
I have not heard of a sterile procedure for lab draws via a CVAD as well but I also have a question regarding blood sampling via a CVAD and would like some clarification.
I have a question regarding which lumen is the recommended lumen fro blood sampling in a mult-lumen catheter. Specifially a staggered TLC, I am under the understanding that the distal lumen is closer to the RA in the SVC and the proximal is further away from RA in the SVC is mu understanding correct? I was also told and have seen in numerous references to use the proximal lumen for lab draws. The INS "Infusion Nursing an evidenced-based approach 3rd edition" states the preferred lumen in the distal lumen. I just need clarification in regards to #1- is my understanding of the lumens in correct? #2- which is the most optimal lumen for blood sampling. I was under the impression that the proximal is recommended when medications infusing in the other lumens cannot be paused during the lab draw, therefore no reflux of medications can occur when infusing in the other distal lumens. I would really appreciate the clarification because the recommendations are varying and I am not clear on why.
The reason why there is confusion about the recommended lumen for drawing blood samples on staggered lumen exit catheters is the misunderstandings about the words distal and proximal. These words require a reference point. For nurses, that reference point is the center of the patient. For engineers designing the catheter, the reference point is themselves. This means that the word distal will be opposite ends of the catheter to these groups of professionals. For a nurse, the distal exit lumen is the highest on the catheter or fartherest away from the catheter tip because the center of the patient is the point of reference. For a nurse the proximal lumen is the one at the tip of the catheter. But these catheters are labeled opposite this way. The distal lumen is the one at the catheter tip because it is the fartherest away from the engineer who designed. The proximal lumen is the one closest to the engineer or the lumen exit highest on the catheter. So when you have a catheter with a staggered lumen exit, you should drawn from the exit that is highest on the catheter, the one fartherest away from the catheter tip. This is based on the idea that drawing from above all infusions will limit the amount of infusing fluids that can get into the blood sample. This does not totally prevent infusing fluids from getting into the blood sample but it would reduce the change. Hope this clears up this problem. I try to avoid use of these words because of this problem. Lynn
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
Below is a link to a video produced in Great Britain as a teaching tool for drawing Blood Cultures
It is very interesting to note the technique that is taught and everyone who watches it should compare their aseptic technique to it
http://www.youtube.com/watch?v=8wWPmn31ZxI&list=UUj5skzT4Ls-X2ypEkcEMxoQ...
Robbin George RN VA-BC Vascular Access Resource Department Inova Alexandria Hospital Virginia
Robbin George RN VA-BC