I am hoping you can help with me a question regarding the 2016 Infusion Therapy Standards of Practice. I received and email from a Phlebotomy Educators at my hospital regarding blood sampling from VADs. The email included a copy of an article from the "Center For Phlebotomy Education." This is the opening paragraph: " The revised standards from the Infusion Nurses Society (INS) instruct nurses and IV therapists to perform venipuncture instead of obtaining blood samples from existing lines or during the insertion of short peripheral catheters. The new standard is a dramatic departure from the prior standard, published in 2011, that advocated draws during IV starts and from vascular access devices (VADs)." I have reviewed both the 2011 and the 2016 Standards of Practice and do not see that a new standard was added. I also am not familiar with the source of this article/information. I have reviewed Standard 43/ Practice Criteria III, D. But do not see any new standard that would support this information in this article. Could you clarify this for me? I certainly appreciate your help.
The Phlebotomy SOP changed signficantly for 2016 due to a lot more evidence. The standard does discourage use of CVADs for drawing blood samples due to new evidence on infection risks with this practice. (Practice Criteria III A). Practice Criteria D is about using a short peripheral catherer for this procedure. Previously this was limited but now there is much more evidence to support using a PIV for drawing blood during its dwell time. The issue is tourniquet time. See II.F.3 - tourniquet time should be less than 1 minute. When a PIV is inserted, the tourniquet is usually on much longer than 1 minute. Drawing blood samples during the phase when the tourniquet is still on can easily lead to skewed results. The procedure should change to finishing PIV insertion with tourniquet removal, stabilization, dressing, etc. Then obtaining the sample after blood flow has returned to normal. This is a procedural issue that is not explored in the SOP but is in the new Policy and Procedure book on page 185. 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 had not read this myself, I'm very disappointed because I have always been an advocate to keep patients from being stuck if they had a CVAD. I believe if its done properly with good aseptic technique then it is best rather than sticking our patients.
Cheryl Ferraro RN, CRNI
Cheryl, please read the standard. It does not state that a CVAD can not be used to draw blood samples. It states that a risk vs benefit assessment is necessary for each patient before you decide. So the policy should never be that ALL CVADs are used for blood drawing; nor should it be that NO CVAD is ever used for this purpose. Think about it this way - when peripheral veins are used for blood drawing you reduce the manipulation of the CVAD, manipulation that can lead to CRBSI. If there is so much manipulation that a BSI occurs, you may have saved a few peripheral sticks but now the patient requires prolonged treatment for the infection, along with needing to have another CVAD inserted with the risk that entails. In this case, the benefit did not outweigh the risk. Even with good technique, manipulation will increase the biofilm and BSI risk. 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