8/11/2019 SKILL 08

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EQUIPMENT

Povidone-iodine wipesAlcohol wipes10 cc syringes (4)

Heparin (10 u/cc)Normal saline flushGloves, nonsterilePovidone-iodine swabs or sticks (culture)Mask (culture)Gloves, sterile (culture)

GENERAL GUIDELINES FOR SPECIMEN

COLLECTION

1. Check physicians order. Ensures appropriate specimenobtained from the correct child.

2. Check child for allergies to any materials used, e.g.,povidone-iodine.

3. Prepare child and family. Enhances cooperation/partici-pation; reduces anxiety/fear.

NOTE: Have an assistant hold/comfort the child as nec-essary and in accordance with agency policy.

4. Gather equipment. Promotes organization and effi-ciency.

5. Wash hands. Don gloves. Reduces transmission ofmicroorganisms.

PROCEDURE

1. Steps 15 of General Guidelines.

2. Position child as necessary to complete procedure.

3. Select lumen for blood withdrawal when child has mul-tilumen catheter.a. Preferable to select largest lumen.b. Avoid using lumen where total parenteral nutrition

(TPN) currently infusing if possible.c. Check for medication/serum sample interactions.

4. Turn off all infusions; clamp other infusions with multi-lumen catheters.Avoids dilution or contamination of

specimen with infusion solution.5. Put on nonsterile gloves. Protects from contact with

blood-borne organisms; reduces transmission ofmicroorganisms.

6. Prep end of injection port as specified by agency policy.One method is to wipe off injection port with three (3)povidone-iodine wipes; allow to dry. Wipe with alcoholwipes. Reduces transmission of microorganisms.Povidone-iodine must dry to be effective. Using alcohol

removes povidone-iodine, which could be introducedinto the central line.

NOTE: Agency policy may require removal of injection

port when drawing blood for culture. When this isrequired, a new injection cap is placed after blood sam-ple is obtained. When drawing blood for culture wearsterile gloves. Put gloves on after cleansing injectionport to maintain sterility of gloves.

7. Wipe injection port with alcohol wipe.Prevents povidone-iodine from being introduced into the central line.

8. Attach syringe with saline flush to injection port. Flushwith 510 cc, enough to equal two to three times theintraluminal volume of the catheter. Clears the tubing ofall infusion solution.

NOTE: Small amounts are used with neonates.

9. Attach empty syringe to catheter. Withdraw blood equalto two to three times the intraluminal volume of thecatheter. Clears the catheter and prevents contaminationof the blood sample with infusion solution.

NOTE: Policy regarding return of withdrawn bloodvaries from agency to agency. Discard or return inaccordance with agency policy. If blood to be returned,it must be drawn into a syringe that contains heparin,generally 1 cc of heparin (10 u/cc).

10. Attach empty syringe onto injection port and withdrawvolume of blood needed for ordered lab tests.

11. Discard or return blood per agency policy. Discard inappropriate container. Maintains body fluid precautions.

12. Attach syringe and flush with normal saline. Clearsblood from catheter and prevents clotting in or blockageof catheter.

13. Resume previous infusion(s) or heparin/saline flush peragency policy.

14. Place blood into appropriate containers.

15. Label containers and place specimen in appropriate bagor container along with laboratory requisition slips.Ensures specimen is properly identified and appropriatetest is performed.

16. Remove gloves. Wash hands. Reduces transmission ofmicroorganisms.

DOCUMENTATION

1. Time, source/site, specimen sent to lab (specify for whattest).

2. Record results of any test performed on the unit.

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SKILL 8SKILL 8 Blood Draw from a Central Venous Catheter