But it could happen with fluid moving from the tip of one lumen into the blood being pulled into the other lumen. Third - you can be drawing PN from one lumen into the aspirate from another lumen - no proof either way. Second - The fibrin/biofilm layer inside that catheter may not release all of the sugar, lytes, etc with a flush and we certainly do not know what volume of flush is required if this layer can be cleared. So I would never, not ever, interupt infusion PN to draw a blood sample. We do not really have all the answers on this issue but there are numerous problems with this practice.įirst, excessive hub manipulation is known to increase the contamination, and therefore infection. Basically, no need evidence that the PN will not alter the lab results before relying on those values for treatment decisions. Those studies were not applicable to what I was searching for so I can not provide the references but your own PubMed search should pull them up. I have been doing several literature searches lately and have come across several studies that touch on your question. I have read the older posts on this issue but could really use some actual references for the practice so that we can get everyone in our facility on the same page as to how we provide patient care. Thank you to anyone that can take the time to reply. Lastly, WHY? Is there any evidence based practice to support the argument that the above mentioned practice is not only OK but that it does not alter lab results if properly flushed, waste discarded, etc.? Where can I find that evidence? Does anyone have any experience with this being an issue?ĥ. The lab personnel have stated concern about the TPN having leached onto the internal lumen and therefore it may alter lab results even with the above stated practice. Is there a certain length of time the TPN must be on hold prior to carrying out the above sequence of events?Ĥ. What is everyone's practice with regards to multi-lumen lines with TPN infusing and lab draw results?ģ. What is everyone's practice with regards to single lumen PICC lines with TPN infusion and lab draw results?Ģ.

I truly feel that saving the patient these multiple lab draws peripherally would be the preferred method. In my opinion, the time it takes from shutting off the infusion, obtaining the materials to do this process and completing it from initial flush to discard of waste should more than allow for the TPN to dissipate within the SVC. I do not know of any actual altered lab results if the practice is followed as stated above. That being said, we have had some questioning from the lab personnel regarding concern for altered lab results based on this practice. Our current policy is to stop the infusion, flush with 20ml NaCl, draw a waste and discard 3-5ml blood, then draw sample followed by a NaCl flush and restart of the infusion as ordered.

Triple lumen central line blood draw