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Blood Collection Venipuncture

Blood Collection From Central Venous Catheter

Obtaining blood collection sample from central venous catheter for routine lab investigations.

Central venous access devices can be used to avoid repeated venipunctures for patients who need frequent drawing of blood samples. Some sources express the view that drawing blood from central lines is not ideal, as the additional manipulation of the hub and the possibility of blood adhering to the inner surface of the catheter can increase the risk of bacterial growth. However, for patients who require frequent venipuncture, the benefits of drawing blood from a central line do often outweigh the risks.

Importance of Blood Collection from Central Venous Catheter

To determine variations if any in blood composition and patient should not get unnecessary needle prick.

Requirements / Equipments

  • Disinfectant for hand hygiene.
  • Sterile Gloves.
  • Syringes
  • Blood Collection Tube.
  • Heparin Flush.

Procedure

  • Gather all articles and explain the procedure to the patient.
  • Wash hands.
  • Apply disinfectant.
  • Attach the syringe to the distal lumen (if multiple lumen) and aspirate 20 cc blood, if any fluid is going through the lumens.
  • Aspirate the amount of blood required for investigation.
  • Push back the blood, which is collected first.
  • Flush the central line lumen with heparin flush.
  • Recap the bivalve.
  • Label the samples accurately, record in the computer and pathology register and send it to the pathology Dept.
  • Segregate generated Bio-Medical Waste as per the HIC policy.
  • Maintain all records.

Complications

Infection

Infection can develop at the insertion site or along the catheter’s path. Common pathogens associated with central line infections are bacteria (such asStaphylococcus aureus), yeast, and fungi.

Sepsis

Sepsis is a severe blood infection caused by bacteria, viruses, and fungi. Sepsis is extremely serious and can be life-threatening. Common manifestations include fever, chills, hypotension, tachycardia, and confusion.

Pneumothorax

Pneumothorax (air in the pleural space, that is, outside the lung) and hemothorax (blood in the pleural space) caused by a puncture of the covering of the lung are possible complications of central venous catheterization. Identification of these complications may be delayed for hours or days, sometimes because of minimal symptoms. The usual manifestations are dyspnea, hypoxia, tachycardia, restlessness, cyanosis, chest pain, and decreased breath sounds on the affected side.

Air Embolism

Air can enter the circulatory system when a central venous catheter is open to the environment, thus causing air embolism. The patient may develop dyspnea, chest pain, tachycardia, hypotension, anxiety, nausea, dizziness, and confusion.

Catheter Occlusion

The lack of blood return or sluggish flow may indicate a catheter occlusion or a malpositioned tip, and further assessment of the line is crucial. Besides those caused by blood clots, called thrombotic occlusions, catheter occlusions can be nonthrombotic, that is, caused by something other than a clot. An example is a mechanical obstruction or impedance of the passage of fluid or medication through the catheter.

Thrombosis

Thrombotic occlusions are caused by clotting inside the catheter or outside around the catheter tip that blocks the catheter’s lumen. This can make it impossible to draw blood from the catheter, to flush it, or to use it for infusion. Heparin and other chemicals might clear the blockage; when those measures do not help, the catheter must be replaced.

Pinch-off Syndrome

When a central catheter is inserted into the subclavian vein, the clavicle and rib can move together and compress the central line catheter, causing pinch-off syndrome. Warning signs include difficulty drawing blood samples and resistance to the infusion of IV fluids.

Catheter Malposition

central catheter can become dislodged as a result of improper technique when removing a dressing, inadequate securing of a catheter, and physical activity. A central catheter migrates when the tip of the catheter changes without the external catheter changing length. For example, the tip could move from the superior vena cava into the internal jugular vein. Changes in intrathoracic venous pressure (coughing, sneezing, vomiting, heavy lifting) could cause the tip to move. With catheter migration, fluids flow against the direction of blood flow.