PROCEDURE FOR DRAWING BLOOD FROM
AN INDWELLING LINE IN CCTC

1. Select Patient
2. Obtain Equipment
3. Prepare Equipment
4. Prepare Environment
5. Prepare Access Cap
6. Connect Blood Withdrawal System
   

7. Position Stopcock for Sampling
8. Collect Discard Sample
9. Collect Samples
10. Flush Catheter
11. Flush Sampling Port
12. Label Specimens
13. Document
    

PROCEDURE

 1.

Select Patient

• Verify order is written or blood test is supported by preprinted order/protocol.
• Order laboratory tests in PowerChart and obtain labels.
• Check labels with patient's armband at bedside to verify correct patient is having blood drawn.

DO NOT REMOVE CLEARLINK CAP TO DRAW SAMPLES. BLOOD MUST BE DRAWN THROUGH THE NEEDLELESS CLEARLINK ACCESS CAP.

 1.

A medical order or supportive protocol is required by the College of Nurses.

The procedure for blood drawing maintains a closed system.

 2.

Obtain Equipment

• Obtain non-sterile gloves and asess risk for need of a face shield.
• LHSC Routine Practices Policy
• LHSC Hand Hygiene Policy
• Vacutainer with indwelling needle for blood collection
• 2% chlorhexidine and 70% alcohol swab
• Blood collection tubes as required to obtain ordered lab tests
• Blood gas syringe if required
• Two additional RED TOP blood collection tubes. One will be used to collect the discard sample and the other will be used to collect backflush.
• Orde labels from powerchart
  

Note: If you are not collecting any blood into vacuum tubes (i.e, blood gases, glucometer samples or point-of-care testing), a syringe can be used to collect the discard sample. A sleeve with slip lock and needlesless access cannula is still required to collect the backflush into a red top tube after blood is collected by syringe.

 2.

The needless system reduces the risk for stopcock contamination and needlestick injuries.

The Lever-Lock(TM) cannula with the clip is used to prevent disconnection during blood withdrawal.

Collection of backflush solution into a disposable blood tube reduces exposure to blood products.

 3.

Prepare Equipment

1. Assemble vacuntainer, tubes and/or blood gas syringe

 3.

 4.

Prepare Environment

1. Explain procedure to patient/family.
2. Press the alarm silence button and hold for 4 seconds if samples are to be drawn from an arterial line.

 4.

Blood sampling from an arterial line reduces patient discomfort from needle sticks, however, patients should be advised that they may feel a warm sensation in their extremity during line fllushing.

When the silence button is pressed once, all alarms are suspended for 2 minutes. When the button is depressed for 4 seconds, the alarm is suspended for 5 minutes. This will prevent nuisance alarms during blood sampling from the arterial line.

 5.

Prepare Access Cap

1. Perform hand hygiene and don non-sterile gloves, face shield if required.
2. Scrub the needleless access cap with 2% chlorhexidine and 70% alcohol swab
3. Allow chlorhexidine to dry for 1 full minute before connecting access cannula

 5

Scrubbing action loosens surface pathogens.

Follow routine precautions and the 4 moments of hand hygiene outlined by LHSC and the MoHLTC.

Antimicrobial effects begin after the chlorhexidine has dried. Evidence favours the use of chlorhexidine for skin preps, to reduce blood stream injections. There is currently no evidence to compare chlorhexidine for injection port cleaning. The Centre for Disease Control (CDC) recommends 70% alcohol or an or an iodophor for cleansing injection sites. Chlorhexidine adheres to provide prolonged gm positive antimicrobial properties.

 6.

Connect Blood Drawing System

Connect vactainer with indwelling needle to the Clearlink cap on stopcock.

 6.

This provides blood access.

7.

Position Stopcock for Sampling

Open stopcock toward patient and sampling port by turning the white prong of the 3-way stopcock toward the flush device. Turn stopcock to 90 degrees.

 7.

This position is open to the patient and the sampling port and closed to the flush device.

8.

Collect Discard Sample

1. Insert one of the red top tubes into the vaccutainer with indwelling needle.
2. Depress the blood tube to activate the vacuum.
3. Turn the stopcock off toward the flush system.
4. Obtain a MINIMUM 3 ml discard if from an arterial line (including if glucometer and blood gas sampling).
5. An 8 ml discard sample is required when drawing blood from a central line.
6. Dispose of discard samples into the sharps container.

Note: If you are not collecting any blood tubes, you can collect discard sample into an extra syringe.

 8.

An adequate discard sample is even more important when a very small blood volume is withdrawn, as the potential for signficant sample dilution is greater.

LHSC Sharps Handling Policy

9.

Collect Blood Samples

1. Turn the white stopcock prong into a 45 degree position before releasing the vaccum or changing tubes/syringe.
2. Remove the discard sample and connect the first blood sample tube or syringe.
3. ALWAYS turn stopcock to 45 degrees before releasing the vaccum on the blood tube, before changing tubes.
4. Draw blue top tubes for aPTT last, but BEFORE blood gas sample.

 9.

When the stopcock is turned to 45 degrees, the stopcock is off in all directions.

If tubes or syringe changes are made when the stopcock is open to the sampling port, blood splatter may occur.

If the stopcock is turned off to the sampling port in a 90 degree position, heparinized flush solution can enter the next sample drawn, diluting or contaminating the results.

10.

Flush the Patient Catheter

1. When all of the desired specimens have been collected, turn the white prong on the stopcock toward the sampling port.
2. Pull the flush device located below the transducer to activate the fast flush mechanism.
3. Flush until there is no visible evidence of blood.
4. Flush central lines or PA lines for one full minute.

 10.

The prong points toward the "off" position. This position is open to the patient and the flush device but closed to the sampling port.

Any blood remaining in the line may trigger clot formation. Central lines and PA catheters have long internal lumens that require a longer flushing time for adequate clearance.

11.

Flush the Stopcock

1. Connect the second extra syringe or blood tube to the sampling port.
2. Turn the stopcock so that the white prong points toward the patient's catheter.
3. Activate the flush device and back flush saline into the red tope tube or syringe.
4. Manipulate the lever lock to ensure all blood is cleared from the Clearlink cap.
5. Replace Clearlink caps that have residual blood.
6. Remove non-sterile gloves, perform hand hygiene.

 11.

Blood provides a medium for bacterial growth.

Backflushing into a contained blood tube reduces caregiver exposure to blood.

In accordance with the MoHLTC 4 moments of hand hygiene and LHSC infection control policies in an effort to reduce risk of transmission of microorganisms and secretions.

LHSC Hand Hygiene Policy

LHSC Routine Practices Policy

12.

Label Specimens

1. Place labels on specimens.
2. Verify that the label name and patient are correct.
3. Sign sample requisition and record time sample was drawn.
4. Send blood samples to the lab in a biohazardous bag.

 12.

Samples will be discarded by lab if unsigned.

13.

Document

1. List sample collected on the nursing graphic record.
2. Ensure an order has been written to obtain blood sample.
3. If blood sample has been drawn according to a prn protocol, document in the AI record the reason the sample was obtained.
4. Record bloodwork results on lab flowsheet and review results with physician.

 12.

Medical orders are required for blood sampling. PRN protocols require documentation of reason sample was collected.

Note that a written order is required for non-protocol driven samples (e.g., cultures, cardiac or hepatic enzymes, urea and creatinine).

To identify need for intervention.