A nurse is preparing to collect a blood specimen for a comprehensive metabolic panel (CMP) from a patient's multi-lumen central venous catheter (CVC). The patient is currently receiving continuous total parenteral nutrition (TPN) through the distal lumen, and the nurse plans to use the proximal lumen for the blood draw. Arrange the following actions in the correct sequential order to ensure accurate laboratory results and maintain catheter patency.
- 1Pause the continuous total parenteral nutrition (TPN) infusion on the electronic pump.
- 2Scrub the needleless connector of the proximal lumen with an antiseptic swab and allow it to dry.
- 3Flush the lumen with 0.9% sodium chloride, then withdraw and discard 5 mL of blood.
- 4Attach a new sterile syringe or blood collection device and withdraw the required blood volume.
- 5Flush the catheter lumen vigorously with 10 to 20 mL of 0.9% sodium chloride using a pulsatile technique.
- 6Restart the continuous total parenteral nutrition (TPN) infusion at the prescribed rate.
Answer
The correct sequence is: Pause the TPN infusion, scrub the hub, flush and withdraw the waste sample, draw the required specimen, flush the line vigorously, and finally restart the TPN infusion.
Accurate blood sampling from a multi-lumen central venous catheter requires a strict aseptic and procedural sequence to prevent diagnostic contamination and line occlusion. Pausing continuous infusions (like TPN) prevents false lab alterations. Scrubbing the hub ensures asepsis. Wasting the initial blood clears the catheter dead space. Drawing the sample provides the clean specimen. Vigorously flushing clears viscous red blood cells to prevent clotting. Finally, restarting the TPN ensures therapeutic continuity.
Step-by-Step Solution
Key Concept
Central Venous Catheter Blood Draw and Parenteral Nutrition Management
Estimated Time:2m 0s