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Central Line Blood Sampling: Procedure (Nursing)

by Samantha Rhea, MSN, RN

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    00:04 After we disconnect our IV tubing, we're going to use that aseptic pad and perform a vigorous mechanical scrub of the needleless connector for at least 30 seconds.

    00:14 So this is really important here because you may have heard that phrase, "scrub the hub" from your instructors or your facilities.

    00:21 This is really important to help cut down on central line infections.

    00:26 This is also important to give it time to allow it to completely dry.

    00:31 Now we want to take our 10 ml normal saline syringe and we're going to put it to the needleless connector.

    00:37 We're going to take that plunger and we're going to pull back.

    00:41 What we're hoping to see here is a little aspiration of blood.

    00:45 Now when we see that blood is in that syringe, now we can flush that lumen with the full 10 mls of normal saline.

    00:53 Once we flushed, we can pull back on that syringe and we're going to aspirate that whole syringe, 10 mls of blood.

    01:02 So this is important here because we're actually going to go ahead and detach and discard all of this 10 mls of blood we just pulled up.

    01:09 That may seem kind of weird to you, but we actually discard the first amount of blood that we get, just to make sure when we take the sample, it's the cleanest sample.

    01:23 So now I'm going to get a new antiseptic pad and we're going to do this to start our procedure to make sure that we cleanse our line thoroughly.

    01:32 So when I do this, I want to make sure I provide a thorough, vigorous mechanical scrub here on my line.

    01:39 So we're going to do this for at least 30 seconds.

    01:43 It's really important not to skip here and make sure that you allow this line to dry completely.

    01:49 That's also really important.

    01:52 So once we've done this, and we've allowed this to air dry, now we can attach our 10 ml normal saline syringe to the line.

    02:00 So this is really important here because we're going to flush first and I'll show you how to do that.

    02:06 So I'm going to go ahead and open up my saline syringe.

    02:13 You notice I'm keeping my hands up now that I've cleaned to try to keep these sterile.

    02:17 So before we get started with our syringe, don't forget to go ahead and prime the fluid, the saline all the way to the top.

    02:25 All right, so now we're ready to use.

    02:27 So now I can go ahead and attach this to my lumen.

    02:31 So now I've attached my 10 ml normal saline syringe.

    02:34 This is really important here that I take my plunger and I pull back on this syringe to aspirate for blood return.

    02:42 Now, of course, today we're using a mannequin for demonstration.

    02:46 But typically if we have a properly working line, you will see blood return coming back in your syringe.

    02:53 So again, we want to make sure this is working properly before we pull back blood and get a sample.

    02:59 So now that we've seen that we've pulled back on our plunger, and we've aspirated blood, and we've noted this, now we can inject our saline into the lumen.

    03:08 So just one thing to know is depending on your lines, there's different mechanisms in the way we flush.

    03:13 So make sure you check your agency policy and what kind of line you're using.

    03:18 Also one thing to note before we get too far.

    03:21 Most central lines, this is pretty typical that we want to use the appropriate size syringe.

    03:27 So notice on a PICC line like you see here, we're using a 10 ml syringe and that's important.

    03:33 So again, make sure you check your patient's particular line and your agency policy.

    03:38 So now that we've got this attached, now we can go ahead and flush.

    03:47 So now that I flush the line thoroughly, a lot of times, it's just easier to use your normal saline syringe already attached, we can go ahead and pull back on the syringe, and we're going to aspirate blood here.

    04:00 So this is what we call our waste.

    04:03 When we get our actual sample we want the most purest sample so we pull back 10 mls, then after we get at least 10 mls of blood, and after we get this, we can go ahead and detach the syringe of aspirated blood.

    04:17 And again, this is the sample that will be discarded, we are not using this for our lab.

    04:27 So now we're going to again take another antiseptic pad a new one perform that vigorous scrub again for at least 30 seconds and allowed to completely air dried.

    04:38 0We're going to take our new 10 ml syringe, we're going to attach it to that needleless connector.

    04:44 And now we're going to go ahead pull back again and aspirate the full 10 mls of blood here.

    04:51 Now once we've obtained our central line blood sample, we can detach this 10 ml syringe from the central line and then we can apply our needless blood colection tube holder to the 10 ml syringe blood sample.

    05:04 Now we can attach the blood collection tubes to that needleless blood collection tube holder to obtain our sample here.

    05:12 Now once we've done this, we can detach the needleless blood collection tube holder from the actual lab tube.

    05:22 Now that we've obtained our discarded sample, I'm going to get a new antiseptic pad and we're going to be sure that we scrub this hub again.

    05:31 And we're going to do this very vigorously for at least 30 seconds and make sure we allow the lumen to dry completely.

    05:43 So again, we've gotten our discarded sample, we've already gotten that already.

    05:48 So now I'm going to give a new empty 10 ml syringe or a luer lock syringe, and we're going to attach this to the central line.

    05:59 So when I do this, now we're pulling back to get our sample.

    06:02 So I'm going to slowly pull back on this 10 milliliter syringe and we're going to aspirate blood.

    06:09 So now that I've got my blood sample, I can detach the 10 ml syringe from the central line.

    06:15 Now we're going to apply our needleless blood transfer device to the 10 ml syringe of our blood sample that we just got.

    06:22 So just know each facility is a little bit different in the equipment they carry.

    06:26 So make sure you follow your agency protocol and get famliar with your equipment.

    06:33 So once we have both of our equipment, I'm going to take my sample, and I'm going to attach it to my needleless blood transfer device here.

    06:42 So do you notice in the device you see a little gray piece here.

    06:46 This is what's actually going to puncture the tube.

    06:49 So now that this is attached, I'm going to get my blood sample.

    06:53 So make sure you check your physician's order and get the appropriate tube.

    06:57 So I'm going to take my tube and it's going to go into my transfer device and when I push up, you will see that the seal is broke and you will see that it starts obtaining your blood sample.

    07:13 So once we do this and we get the appropriate labs and the appropriate orders, you're able to switch these out as needed.

    07:21 Same thing here, I'm going to push this to break the seal of the tube.

    07:27 Going to make sure this fills appropriately and just know each tube needs a little bit different amounts, so make sure you check your equipment.


    About the Lecture

    The lecture Central Line Blood Sampling: Procedure (Nursing) by Samantha Rhea, MSN, RN is from the course Central Line Care (Nursing).


    Included Quiz Questions

    1. Scrub the port with antiseptic for at least 30 seconds and let it dry completely before sampling.
    2. Scrub the port with antiseptic for at least 15 seconds and let it dry completely before sampling.
    3. Scrub the port with antiseptic for 30 seconds and attach the Vacutainer while the port is wet with antiseptic.
    4. Scrub the port with antiseptic for 20 seconds and use the port while it is still wet.
    1. Pull back on the syringe and confirm there is blood return.
    2. Scrub the sampling port again with antiseptic.
    3. Nothing, the nurse can proceed to flush the port with 10 mL of saline.
    4. Inject 3ml of saline and then withdraw 7 mL of blood.
    1. To ensure the blood that is sent to the lab is fresh and uncontaminated.
    2. The first 10 mL of blood will be clotted.
    3. Since 10 mL of saline was injected, 10 mL of blood needs to be taken out.
    4. The first 10 mL of blood must be discarded to sample blood closest to the heart.
    1. It punctures the blood tube so that blood can be injected.
    2. It prevents the blood from clotting during the sampling process.
    3. It creates a vacuum so the blood can enter the tube.
    4. It connects the needleless blood collection tube holder to the 10cc syringe.
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    Author of lecture Central Line Blood Sampling: Procedure (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN


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