I.V. Nurses Day is Sunday, January 25 and we would like to extend our best wishes and congratulations to our colleagues working diligently to provide safe infusion therapy all over the world! In honor of this special day, we have been working hard on a new online course Blood Sampling: Venipuncture or Vascular Access Device? Obtaining blood samples for lab testing can present clinical challenges. Numerous factors cause pre-analytic errors - those errors occurring before the sample reaches the laboratory. Additionally, there could be a choice of a new venipuncture, obtaining the sample when the peripheral catheter is inserted, or drawing the sample from an existing vascular access device. This decision requires knowledge of the evidence and your patient assessment. The goal is always methods and techniques that produce accurate lab values in a timely manner. Numerous techniques, such as the length of tourniquet time, have a direct impact on the results of lab values. Or a hemolyzed sample cannot be used for the needed lab values. Clinical decisions based on spurious lab values cause adverse clinical events, drive up the costs of care, and waste valuable time and resources. We have scoured the literature to find all available studies addressing these and many other issues with blood sampling. This evidence and associated recommendations for specific techniques are explored in this course. All healthcare professionals with the responsibility for drawing blood samples must know the best ways to obtain the blood sample. Published evidence does not provide answers to every question, but we were able to find a surprising amount of information for this course. Course Learning Objectives 1. Identify pre-analytical problems associated with all blood sampling practices. 2. Specify the risks associated with obtaining blood samples and plan ways to reduce these risks. 3. Analyze the techniques for phlebotomy via a direct venipuncture. 4. Analyze the techniques for obtaining blood samples from a vascular access device. We still have a little more work to do, but wanted to let everyone know that it is coming soon. To receive early notification when this course is released, and to learn about registration, go to http://www.hadawayassociates.com and sign up to receive our newsletter. Our plan is to have it ready by February 1. And we will offer a discount in honor of I.V. Nurses Day. Vascular access devices inserted via the femoral vein have always been controversial, but necessary in some patients. The 2014 SHEA Compendium states, “Avoid using the femoral vein for central venous access in obese adult patients when the catheter is placed under planned and controlled conditions.” The 2011 CDC Guidelines states, “Avoid using the femoral vein for central venous access in adult patients.” The percutaneous insertion site may lead to a greater risk of complications, especially if the patient is ambulatory.
Another issue is tip location and confirmation of that location. Many have the mistaken idea that this aspect is not as important for a CVAD inserted through the femoral vein, but why would it be less important than those inserted through veins of the upper extremity or thorax? The 2011 INS Standards of Practice addresses these issues in many standards.
Here is one case report of a femoral catheter entering the left ascending lumbar vein, but there are other case reports like this in the literature. The INS Standards of Practice state, “Tip location of a CVAD shall be determined radiographically or by other approved technologies prior to initiation of infusion therapy.” This would apply to CVADs inserted via all veins including femoral vein insertions. Recently I did a podcast with INS on business case for infusion teams. Follow the link to listen.
http://ins.podcasts.commpartners.com/feed/44 |
Author: Lynn HadawayLynn Hadaway is an international thought leader in infusion therapy and vascular access, having been in this practice for more than 40 years. Her experience comes from hospital-based infusion teams, device manufacturers, and continuing education services. Her journal and textbook publications are extensive. She also maintains board certification in infusion nursing (CRNI) and nursing professional development (RN-BC). Categories
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May 2019
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