A nurse is preparing to draw a blood specimen for laboratory analysis from a client's multi-lumen central venous catheter. Continuous intravenous fluids are currently infusing through the other lumens. Arrange the following actions in the correct chronological sequence to safely obtain the blood sample.
- 1Pause all continuous intravenous infusions on the other lumens of the central venous catheter.
- 2Scrub the needleless connector hub with an antimicrobial swab and allow it to dry completely.
- 3Attach a syringe with 0.9% sodium chloride, unclamp the catheter, and flush to assess for patency.
- 4Aspirate and discard an initial volume of 5 to 10 mL of blood.
- 5Attach a new sterile syringe and withdraw the required volume of blood for the laboratory specimen.
- 6Flush the lumen vigorously with 10 to 20 mL of 0.9% sodium chloride using a pulsatile technique.
Answer
The correct sequence is to first pause all other infusions, then scrub the hub, flush to check patency, draw and discard the initial waste blood, draw the required lab specimen, and finally flush the line vigorously with normal saline.
Safely drawing blood from a central venous catheter requires a strict sequence to prevent infection, preserve catheter patency, and ensure accurate laboratory results. Pausing other infusions prevents sample contamination. Scrubbing the hub maintains asepsis. The initial flush verifies patency. Drawing a discard volume is critical to clear the catheter's dead space of flush solutions. After the pure specimen is collected, a large-volume pulsatile flush is required to clear all red blood cells and prevent catheter thrombosis.
Step-by-Step Solution
Key Concept
Central Venous Catheter (CVC) Blood Sampling Protocol