4.5 Checklist: Obtain a Blood Sample From a CVAD

*Disclaimer: Always follow agency policy and manufacturer recommendations

Checklist: Obtain a Blood Sample From a CVAD^[1],[2]

• Verify the provider’s order.
• Gather the necessary equipment:
  • Gloves
  • 10-mL prefilled syringes containing preservative-free normal saline flush solution (or syringes specifically designed to generate lower injection pressure)
  • Antiseptic pads or scrubs (chlorhexidine-based, povidone-iodine, or alcohol)
  • Appropriately sized syringes or needleless blood collection tube holder
  • Blood collection tubes
  • Labels
  • Laboratory biohazard transport bag
  • Puncture-resistant sharps disposal container
• Perform hand hygiene.
• Confirm the client’s identity using at least two patient identifiers and check allergies.
• Provide privacy.
• Explain the procedure to the client and family (if appropriate) and answer any questions.
• Put on gloves and, if splashing is likely, put on a mask with a face shield or a mask and goggles.
• Raise the bed to waist level when providing care.
• Trace the tubing from the client to its point of origin.
• Stop any infusing IV fluids, including those running through another lumen of the catheter. Follow agency policy for how long the IV fluids must be stopped before the blood draw. Clamp the lumen, if appropriate. Detach the administration set from the needleless connector and place a sterile cap over the end of the administration set, if necessary.
• If no IV fluids are infusing and an antiseptic-impregnated sterile cap is covering the end of the needleless connector, replace it according to agency policy. For example, if drawing blood for blood cultures, agencies may require changing the cap before the blood draw to prevent contamination of blood culture results.
• Perform a vigorous mechanical scrub of the needleless connector for at least 15 seconds using an antiseptic pad. Allow it to air dry; do not fan or wave over it.
• While maintaining sterility of the syringe tip, attach a prefilled syringe containing preservative-free normal saline solution to the needleless connector. Unclamp the catheter and slowly aspirate for blood return. Troubleshoot if no blood return occurs; notify the practitioner if troubleshooting is ineffective.
• If blood return occurs, slowly inject the preservative-free normal saline solution into the catheter.
• Using the attached syringe used for flushing, aspirate the same volume of blood as amount of saline used to flush the catheter.
• Clamp the catheter and remove and discard the blood collection tube or syringe.
• Perform a vigorous mechanical scrub of the needleless connector for at least 15 seconds using an antiseptic pad, allow it to dry, connect an empty syringe to the catheter, release the clamp, and withdraw the blood sample.
• Clamp the catheter and remove the syringe.
• Change the needleless connector according to the manufacturer’s instructions.
• Perform a vigorous mechanical scrub of the needleless connector for at least five seconds using an antiseptic pad; allow it to dry.
• While maintaining sterility of the syringe tip, attach the syringe containing preservative-free normal saline solution.
• Unclamp the catheter, slowly inject the preservative-free normal saline solution into the catheter, and then reclamp the catheter.
• Remove and discard the syringe.
• Continue the client’s prescribed continuous IV infusion; if the client doesn’t have a continuous infusion prescribed, proceed with locking the device if required by the facility. Discard the syringe.
• Place a new antiseptic-impregnated sterile cap, if available at the facility, on the needleless connector after locking it with saline.
• If blood was obtained using a syringe, use the blood transfer unit to transfer the blood into appropriate blood collection tubes.
• Label the samples in the presence of the client.
• Place all blood collection tubes in a laboratory biohazard transport bag and send them to the laboratory with a completed laboratory request form.
• Dispose of used equipment in appropriate receptacles.
• Remove and discard gloves and other personal protective equipment.
• Perform hand hygiene.
• In an inpatient setting, help the client into a comfortable position and place personal items, the tray table, and the call light within easy reach. Make sure the client knows how to use the call light to summon assistance. To ensure the client’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. Ensure the bed is locked.
• Perform hand hygiene.
• Document the procedure and assessments.

Documentation Cues:

• Date and time the blood sample was drawn
• Volume of blood withdrawn
• Lumen used if the client has a multi-lumen central venous access catheter
• Laboratory tests for which the sample was drawn
• Time the sample was sent to the laboratory
• Assessment of the catheter exit site and the patency of the catheter
• Absence of signs and symptoms of complications
• Presence of blood return on aspiration
• Lack of resistance when flushing
• Amount and types of flushes used
• Teaching provided to the client and family (if applicable), understanding, and follow-up teaching needed