Obtaining Coagulation Blood Samples From Central Venous Access Devices: A Review of the Literature

The discard technique is the most widely used method of obtaining blood samples from patients with central venous access devices (CVADs), but risks removing more blood than is necessary for laboratory testing and may increase a patient’s risk of anemia. We hypothesized that laboratory results from pediatric blood specimens obtained via CVAD using the single-syringe push-pull (formerly called the mixing) method and the discard method would be similar. Blood samples were obtained from pediatric oncology patients in a hospital setting using both collection methods and laboratory values were analyzed for concordance using the pairwise t-test, intraclass correlation coefficient, and Bland-Altman analysis methods. Statistical analysis revealed significant differences for sodium, potassium, chloride, bicarbonate, creatinine, calcium, white blood cell count, hemoglobin, hematocrit, and platelet count, but these differences were not clinically significant and within the standard error of measurement for the instrument. Given the similarity in laboratory results, the push-pull method should be considered for obtaining blood samples from CVADs in pediatric patients to avoid unnecessary blood loss.

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The Use of Hepzyme in Removing Heparin From Blood Samples Drawn From Central Venous Access Devices

Journal of Pediatric Oncology Nursing ◽

10.1053/jpon.2000.8066 ◽

2000 ◽

Vol 17 (3) ◽

pp. 179-181 ◽

Cited By ~ 4

Author(s):

Kathy Forte ◽

Thomas Abshire

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Blood Samples ◽

Venous Access Devices

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ECHOTIP-Ped: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients

The Journal of Vascular Access ◽

10.1177/11297298211031391 ◽

2021 ◽

pp. 112972982110313

Author(s):

Geremia Zito Marinosci ◽

Daniele Guerino Biasucci ◽

Giovanni Barone ◽

Vito D’Andrea ◽

Daniele Elisei ◽

...

Keyword(s):

Pediatric Patients ◽

Central Venous Access ◽

Venous Access ◽

Bedside Ultrasound ◽

Pediatric Care ◽

Ultrasound Guided ◽

Central Venous ◽

Blood Samples ◽

Promising Tool ◽

Venous Access Devices

Central venous access devices are routinely used in pediatric care for administration of fluids and medications and for drawing blood samples. The adoption of ultrasound guided venipuncture, the availability of bedside ultrasound devices and the use of intraprocedural methods for tip location have been shown to reduce procedure-related complications, as documented by the recommendations of most recent guidelines. In pediatric patients, bedside ultrasound is a promising tool not only for optimizing the choice of the vein and guiding the venipuncture, but also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in pediatric patients, and to suggest a structured protocol for clinical practice.

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Upper Extremity Deep Venous Thrombosis in Cancer Patients with Venous Access Devices - Prophylaxis with a Low Molecular Weight Heparin (Fragmin)

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650254 ◽

1996 ◽

Vol 75 (02) ◽

pp. 251-253 ◽

Cited By ~ 264

Author(s):

Manuel Monreal ◽

Antoni Alastrue ◽

Miquel Rull ◽

Xavier Mira ◽

Jordi Muxart ◽

...

Keyword(s):

Cancer Patients ◽

Upper Extremity ◽

Statistical Significance ◽

Central Venous Access ◽

Venous Access ◽

Bleeding Complications ◽

Fisher Exact Test ◽

Central Venous ◽

True Incidence ◽

Venous Access Devices

SummaryCentral venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism.We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily for 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested.On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% Cl: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 ±145 vs 207 ±81 X 109/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

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Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices

Reviews on Recent Clinical Trials ◽

10.2174/1574887113666180817125036 ◽

2019 ◽

Vol 14 (1) ◽

pp. 47-49

Author(s):

Basant K. Puri ◽

Anne Derham ◽

Jean A. Monro

Keyword(s):

Bloodstream Infection ◽

Antibiotic Treatment ◽

Central Venous Access ◽

Case Series ◽

Bloodstream Infections ◽

Venous Access ◽

Host Cells ◽

Central Venous ◽

Intravenous Antibiotic ◽

Venous Access Devices

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.

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