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Accessing and Drawing Blood from an Externalized CVC (Broviac, Hickman, PICC)
ОглавлениеAs noted above, the procedure for accessing an externalized CVC must follow strict aseptic technique. ED personnel should have all necessary equipment open and ready prior to accessing the line. Table 5.1 describes the steps necessary to access an externalized CVC. If blood samples are to be drawn from the catheter, an attempt should be made to use the CVC's largest lumen of the for this purpose. If blood cultures are needed, a sample should be drawn from each lumen of the catheter and labeled carefully to indicate its lumen of origin. In general, blood samples withdrawn from a CVC should be labeled as such, so that any erroneous or unusual lab results may be interpreted in the context of the line's usual use (e.g. an extremely high blood glucose level drawn from a line ordinarily used to infuse parenteral nutrition).
Table 5.1 Procedure for accessing an externalized central venous catheter.
| Identify the patient and explain the procedure to the patient and family.Position the patient safely. Supine positioning is preferred; women and adolescent girls should have their brassiere removed on the side of the catheter.Perform hand hygiene and don sterile gloves. Some institutions will also require practitioners to wear a mask and/or sterile gown.Prime all tubing and connectors to be used in the procedure to purge them of air.Place a sterile towel or drape under the externalized portion of the catheter.If the patient's CVC does not have its own clamp, clamp the line at least 3 in. proximal to the cap using forceps without teeth.Remove the catheter cap and scrub the hub with alcohol, allowing it to dry fully (at least 5–10 seconds).Attach a 10 cc syringe of normal saline; unclamp the catheter and slowly inject up to 5 cc of saline. If the line flushes easily, aspirate the instilled fluid and check for blood return.If there is resistance to fluid infusion or no blood return with aspiration, the line is likely occluded (see the section on troubleshooting an occluded CVC). Recap the line and do not inject fluids or medications into the occluded line.If there is successful blood return with aspiration, instill the remaining saline in the syringe. Clamp the line and remove the syringe.If the line is needed for blood drawing, aspirate 3–5 cc from the line prior to clamping, as in Step 10. Discard this saline‐and‐blood mixture, and attach a new, empty syringe to the catheter cap. Unclamp the catheter and withdraw the needed volume of blood. Reclamp the catheter, attach a second 10 cc syringe of saline, unclamp the catheter, and flush the line to clear blood from the line. Clamp the catheter after flushing and remove the syringe.If the line is needed for infusion of medications or fluids, connect primed IV tubing to the catheter hub, unclamp the catheter, and administer fluids or medications as care dictates. |
