/policies/,/policies/clinical/,/policies/clinical/uwmf-clinical/,/policies/clinical/uwmf-clinical/uwmf-wide/,/policies/clinical/uwmf-clinical/uwmf-wide/clinical-policies-and-procedures/,/policies/clinical/uwmf-clinical/uwmf-wide/clinical-policies-and-procedures/central-lines/,

/policies/clinical/uwmf-clinical/uwmf-wide/clinical-policies-and-procedures/central-lines/102003.policy

201410303

page

100

UWMF,

Policies,Clinical,UWMF Clinical,UWMF-wide,Clinical Policies and Procedures,Central Lines

Blood Draws From Central Venous Catheters (102.003)

Blood Draws From Central Venous Catheters (102.003) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Central Lines

102.003

1
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: BLOOD DRAWS FROM CENTRAL VENOUS CATHETERS

Effective Date: May, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed Feb., 2008 May, 2009 June 2012


PURPOSE: To provide guidelines for drawing blood via a central venous catheter at UWMF & DFM Clinics.

DEFINITIONS:
Central venous catheters are used to give long-term medicine treatment for pain, infection, or cancer, or to supply
nutrition. A central venous catheter can be left in place far longer than a peripheral intravenous catheter (PIV), which
gives medication into a vein near the skin surface. The tip of all central venous catheters is in the superior vena cava
(SVC). There are several types of central venous catheters.
PICC line: (Groshong, Open-ended, Power) A peripherally inserted central catheter, or PICC line, is a central venous
catheter inserted into a vein in the arm and then threaded into the SVC.

Tunneled catheter: (Groshong, Open-ended, Power) This type of catheter is tunneled under the skin and placed in one of
the veins just under the collarbone. It is held in place by a textured cuff that lies under the skin. Only the end of the
catheter is brought through the skin.
Implanted port: (Groshong, Open-ended, Power) This type is similar to a tunneled catheter but the exit site is left
entirely under the skin. Medications are injected through the skin into the catheter via a non-coring needle.
Catheter tip types:
Groshong – tip is rounded with slit-type opening that opens and closes with flow of fluid/med/etc. Does not require
heparin flush for maintenance.
Open-ended – tip is open-ended. Requires heparin flush for maintenance.
Power – usually purple in color, able to withstand pressures needed to accommodate contrast.


PICC line Implanted Port Tunneled Catheter

POLICY: Nurses and lab staff will utilize the following guidelines to properly draw blood from a central
venous catheter.


2
SUPPLIES:
provider’s order
tubes for ordered test(s)
normal saline
heparin (if indicated for line and valve type)
alcohol preps
labels w/patient name, medical record number, date, initials
Replacement valve for PICC or tunneled lines
Vacutainer method:
o Blue adapter, vacutainer needle, 10 ml red-top tube to discard
o NOTE: may use the prefilled saline syringe used to flush line to draw discard
Syringe Method:
o 20-gauge needle with syringe (size specific for test), 6ml syringe to discard

PROCEDURE:

1. Check provider’s order and clarify any inconsistencies.

2. Wash hands and gather equipment.

3. Introduce yourself. Identify the patient by full name and date of birth. Provide Privacy.

4. Explain procedure to the patient and answer any questions.

5. Assemble equipment.

6. Apply clean gloves.

7. Access line - Refer to appropriate policy for this procedure:
Line Maintenance of Central Venous Catheters (PICC and Tunneled Lines)
Venous Access Ports- Accessing & De-accessing

8. Flush the line with 10 ml normal saline.

9. Using either a vacutainer or syringe, aspirate the amount to discard (one tube or 10ml syringe).

10. Using either a vacutainer or syringe, aspirate blood and introduce it to specific tubes needed for ordered
tests.
NOTE: Gently mix tubes that contain anticoagulants.

11. Flush the line with 20ml normal saline.

12. Flush with heparin, if applicable for line and valve type (see attached chart).

13. Make the patient comfortable.

14. Remove gloves and wash hands.

15. Label all tubes, place in specimen biohazard bag. Send specimen to lab.


3
16. Discard all equipment in appropriate containers.

17. Documentation in Progress Notes section of HealthLink:
Patient education
Procedure performed, date & time completed
How the patient tolerated the procedure
Discharge instructions
Follow-up appointment (if any)


WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support

REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator, 2012

REVIEWED BY: LaVay Morrison, RN, BSN, Clinical Staff Educator, 2012
Shar Ballentine, RN, BSN, Clinical Program Coordinator, Chartwell Midwest Wisconsin
Brenda Maass, Team Leader Central Lab
Susan Antonie, RN, Hematology/Oncolocgy Clinic, UWMF
Julie Nampel, RN, Clinic Mgr, Hematology/Oncology, UWMF & GYN/Med/Oncology, UWHC
Rebecca Harrison, RN, Urgent Care, Team Lead
Brian Tish, RN, Urgent Care, Team Lead

REFERENCES:

Infusion Nurses Society. (2006). Policies and procedures for infusion nursing. (3rd ed.). Infusion Nurses
Society.

UWHC Departmental Policy 1.21. (April 2, 2012). Central venous catheters, adult and pediatric. U-connect, faculty and staff intranet
for UW Health. Available at:
https://uconnect.wisc.edu/servlet/Satellite?cid=1095721213003&pagename=B_EXTRANET_UWHC_POLICIES%2FFlexMember%
2FShow_Policy&c=FlexMember.


AUTHORIZED BY: Richard Welnick, MD, Medical Director, UWMF Ambulatory Clinic Operations
Sandra A. Kamnetz M.D., Vice Chair, Department of Family Medicine


_______________________________________________________________________________
Medical Director, UWMF

________________________________________________________________________________
Vice Chair, Department of Family Medicine


4
Recommended Line Maintenance per Type of Line and Valve

SAS = Saline, Administer/Procedure, Saline
SASH = Saline, Administer/Procedure, Saline, Heparin
NS = Normal Saline
Type of CVC Valve Type Flush Flush when
Not in Use
Other
PICC
Groshong

SAFSITE

SAS with 10 ml NS

Weekly with 10ml NS

Clamp line, then remove
syringe.
Change cap after each use
MaxPlus SAS with 10 ml NS Weekly with 10ml NS Remove syringe, then
clamp line.
Scrub the hub with
alcohol for 20 sec prior to
each use.
SmartSite SAS with 10 ml NS Weekly with 10ml NS Remove syringe, then
clamp line.
Scrub the hub with
alcohol for 20 sec prior to
each use.
Open-ended SAFSITE SASH with 10 ml NS and
5 ml heparin 100U/ml
Daily with 5 ml heparin
100U/ml
Clamp line, then remove
syringe.
Change cap after each
use.
MaxPlus SAS with 10 ml NS Daily with 10 ml NS Remove syringe, then
clamp line.
Scrub the hub with
alcohol for 20 sec prior to
each use.
SmartSite SASH with 10 ml NS and
5 ml heparin 10U/ml
Daily with 5ml heparin
10U/ml
Clamp line, then remove
syringe.
Scrub the hub with
alcohol for 20 sec prior to
each use.
Power SAFSITE SASH with 10 ml NS and
5 ml heparin 100U/ml
Daily with 5 ml heparin
100 U/ml
Clamp line, then remove
syringe.
Change cap after each
use.
MaxPlus SAS with 10 ml NS Daily with 10 ml NS Remove syringe, then
clamp line.
Scrub the hub with
alcohol for 20 sec prior to
each use.
SmartSite SASH with 10 ml NS and
5ml heparin 100 U/ml
Daily with 5 ml heparin
100 U/ml
Clamp line, then remove
syringe.
Scrub the hub with
alcohol for 20 sec prior to
each use.








5
Type of CVC Valve Type Flush Flush when
Not in Use
Other
Tunneled
Groshong
SAFSITE SAS with 10 ml NS Weekly with 10 ml NS Clamp line, then remove
syringe.
Change cap after each
use.
MaxPlus SAS with 10 ml NS Weekly with 10 ml NS Scrub the hub with
alcohol for 20 sec prior to
each use.

SmartSite

SAS with 10 ml NS

Weekly with 10 ml NS

Scrub the hub with
alcohol for 20 sec prior to
each use.
Open-ended SAFSITE SASH with 10 ml NS and
5ml heparin 10 U/ml
Daily with 5ml heparin 10
U/ml
Clamp line, then remove
syringe.
Change cap after each
use.
MaxPlus SAS with 10 ml NS Daily with 10 ml NS Remove syringe, then
clamp line.
Scrub the hub with
alcohol for 20 sec prior to
each use.
SmartSite SASH with 10 ml NS and
5ml heparin 10 U/ml
Daily with 5ml heparin 10
U/ml
Clamp line, then remove
syringe.
Scrub the hub with
alcohol for 20 sec prior to
each use.
Implanted
Port
Groshong

SAFSITE

SAS with 20 ml NS

Monthly with 20 ml NS
Clamp line, then remove
syringe.
Change cap after each
use.
MaxPlus SAS with 20 ml NS Monthly with 20 ml NS Remove syringe, then
clamp line.
Scrub the hub with
alcohol for 20 sec prior to
each use.
SmartSite SAS with 20 ml NS Monthly with 20 ml NS Clamp line, then remove
syringe.
Scrub the hub with
alcohol for 20 sec prior to
each use.
Open-ended SAFSITE SASH with 10 ml NS and
5ml heparin 10 U/ml
Monthly with 5 ml heparin
100 U/ml
Clamp line, then remove
syringe.
Change cap after each
use.
MaxPlus SAS with 20 ml NS Monthly with 20 ml NS Remove syringe, then
clamp line.
Scrub the hub with
alcohol for 20 sec prior to
each use.
SmartSite SASH with 10 ml NS and
5ml heparin 10 U/ml
(while accessed)
Monthly with 5ml heparin
100 U/ml
Clamp line, then remove
syringe.
Scrub the hub with
alcohol for 20 sec prior to
each use.

6