Withdrawal of Blood from Central Venous Access Device for Blood Sampling Procedure

Transcription

1 SH CP 143 Withdrawal of Blood from Central Venous Access Device for Blood Sampling Procedure (e.g. for skin tunnelled central catheter, peripherally inserted central catheter) Summary: Keywords (minimum of 5): (To assist policy search engine) Target Audience: Trust procedure for withdrawal of blood from central venous access device for blood sampling procedure (e.g. for skin tunnelled central catheter, peripherally inserted central catheter). Intravenous therapy, IV therapy devices, PICC, skin tunnelled, implanted port, cannulation, peripheral cannula, midline, insertion, maintenance, removal, flush, diluent, reconstitution, infiltration, extravasation, VIPscore, vesicant, phlebitis, thrombosis, thrombophlebitis infusion, CVAD, blood. Registered Nurses Doctors Next Review Date: March 2017 Approved and ratified by: Quality Improvement and Development Forum. Virtual Policy Group Date of meeting: 8 November 2013 Author: Sponsor: Sue Benzie, Suzie Ingram, Jane Byrnell Jude Diggins, Director of Nursing and AHP 1

2 Version Control Change Record Date Author Version Page Reason for Change Aug Jane Byrnell 1 All Replace ANTT terminology with Aseptic Technique /9/16 1 Review date extended from Nov to Dec /12/16 1 Review date extended to March 2017 Reviewers/contributors Name Position Version Reviewed & Date Theresa Lewis Head of Infection Prevention and Control 1 David Jones Chief Pharmacist 1 Steve Menear Senior Clinical Pharmacist 1 Zoe Denyer Inwood Day unit Sister 1 Steve Coopey Practice Development Specialist Nurse 1 2

3 Withdrawal of Blood from Central Venous Access Device for Blood Sampling Procedure NB: do not attempt blood collection from Peripheral Cannulae or Midline peripheral catheters Practitioner to have relevant information regarding Central Venous Catheter inserted: Type and name of line inserted Date of insertion and date of X-ray confirming proximal tip location Length of line inserted Length of exterior line exposed Identify correct hub for access to blood sampling if multiple lumens. (Usually the distal lumen as this is the largest; often red in colour). Patients receiving parenteral nutrition should have single lumen catheter in situ or dedicated lumen for parenteral nutrition. Action Identify clinical need for blood sampling from the Central venous catheter. Decontaminate hands as per Southern Health Hand Hygiene Procedure. Identify patient by surname, first name and date of birth using open questions checking against NHS number. Explain the procedure to the patient; discuss the need for a blood sample, obtaining informed consent for procedure, establishing whether patient has any know allergies. Refer to the Mental Capacity Act 2005 if appropriate and consider the patients best interests. Inspect the catheter exit site for signs of skin discolouration or signs of infection using a Visual Infusions Phlebitis Score (VIPS) and document accordingly. Ascertain whether the patient has experienced any new symptoms of pain, discomfort or swelling; whether the catheter has been pulled or caught since previous therapy; whether the exterior length of the line remains constant. If you suspect infection or have concerns that Catheter cannot be aspirated; contact your local Hospital Specialist Nurse for advice or refer to the GP/Medical Clinician or Consultant s Team if shared care. Decontaminate hands as per Hands Hygiene Procedure. Ensure working area is cleaned as per Rationale To prevent inappropriate intervention and exposure to associated risks. To reduce the risk of infection. To ensure correct identification of the patient. To ensure patient is informed of procedure and the risk of allergic reaction is eradicated. To ensure consent for insertion is obtained and that the insertion of the device is appropriate for the patient. To assess for risk of infection being present. To assess whether the catheter may be malpositioned or displaced. In these circumstances X-ray is required to confirm position of catheter tip. To ensure patient safety and resolution of problem. 3

4 Aseptic Technique and Clean Technique Procedure. Ensure all equipment is gathered before commencing the procedure. Put on disposable plastic apron. Open sterile pack allowing inner pack to fall onto cleaned working area. Open out sterile pack to create an aseptic field. Open remaining equipment (10mL luer lock syringes, Filter needle, blood transfer device) onto aseptic field, ensuring no contamination occurs. Open onto aseptic field the correct number of device cleansing wipes -2% chlorhexidine gluconate in 70% Isopropyl alcohol e.g. Clinell Single Use Device wipes or suitable alternative. Decontaminate hands as per Hand Hygiene Procedure. Put on clean non sterile gloves. Using aforementioned cleansing agent/wipes, and Aseptic Technique, scrub all blood sampling bottles, and ampoule for flush, for 30 seconds to 1 minute, and place on edge of aseptic field and allow to air dry for 30 seconds to 1 minute. Using recommended cleansing agent/wipes and Aseptic Technique, thoroughly scrub hub/port of Central Venous Catheter, line (and clamp) for minimum 30 seconds to 1 minute, and place hub/port onto sterile paper towel to air dry for 30 seconds to 1 minute. Remove gloves, decontaminate hands and put on sterile gloves. Connect 5 micron safety filter needle/ 23G safety blue needle to the syringe. Use 10mL luer lock syringes or refer to Manufacturer recommendations and draw up ml 0.9% sodium chloride for injection flush as prescribed. NB: There are pre-prepared 10mL syringes containing 0.9%sodium chloride for injection available (e.g. BD Posiflush) which remove the need to use needles to draw up the solution from an ampoule. Dispose of the needle directly into sharps container as per Sharps Safety and Management Policy. Place the filled syringe on the aseptic field, cover and protect with sterile gauze swab. Attach empty minimum size 10ml luer lock syringe into hub/port and aspirate at least To promote safe and efficient working. To use for cleansing hub/port, ampoules and blood sampling bottles. To prevent cross infection. To render aseptic. To render and prevent cross infection. Evidence has shown that hands can be contaminated on removal of gloves. To prevent aspiration of particulates from glass ampoules. To prevent excessive pressure and promote safe connection to device. To prevent needle stick injury. To reduce risk of cross infection. To prevent contamination of sample from any previous medication situated in the 4

5 6ml -10ml of blood from the Central Venous Catheter to discard. If requiring blood for an INR sample, at least 10-20mls of blood should be aspirated and syringe discarded before taking the sample for analysis. Blood filled syringe to be discarded as per Handling and disposal of Waste policy immediately into the sharps container. If unable to withdraw blood, ask patient to cough/raise arm/lean forward /turn head; if necessary flush with 2mLs 0.9% sodium chloride (do not use force) then repeat attempt to aspirate from the catheter. Using Aseptic Technique, attach empty 10ml Luer Lock syringe to hub/port and aspirate volume of blood required for blood sample. Connect the syringe(s) holding the collected blood to a sterile Blood Transfer Device and attach to this device the blood sample bottles as required in the correct order remembering to invert tubes as required immediately after sample collection. (The blood will automatically be transferred from syringe to sample tubes.) Dispose of syringe and blood transfer device as one unit into the sharps box. Attach syringe with sodium chloride 0.9% for injection and flush with 10-20mLs using intermittent push pause technique and positive pressure technique as described in the section on flushing, and according to whether valved or non-valved Central Venous Catheter being used. Ensure that the catheter is secure and that the patient is comfortable. Remove dressing towel and discard. Remove gloves aprons. Decontaminate hands. Dispose of all waste correctly following Handling and Disposal of Healthcare Waste Policy. Ensure correct labelling of blood bottles at the patient s bedside. Document in patient s records the samples taken, flush administered, any problems encountered and action taken. lumen. To encourage movement of central venous catheter away from vein wall which may be causing occlusion. To ascertain whether a fibrin sheath is acting as a one way valve, allowing flush but prohibiting aspiration of blood. To ensure that no more blood than is requested is collected. To ensure that the blood bottle order of draw is preserved. To prevent splashing of blood. Inversion of blood bottle will ensure thorough mixing of blood with additive. To prevent injury. To create turbulent flow, which promotes patency. To prevent air embolism. To prevent dislodging the Central Venous Catheter. To prevent cross infection. To ensure that sample bottles are not mislaid/confused with other sample bottles. To maintain records as per Record Keeping Policy. To ensure comprehensive communication and maintain continuity of care. 5