Purpose: To insure proper techniques are utilized when obtaining blood specimens from umbilical catheters in the Special Care Nursery.Policy: Blood collection from UAC and/or UVC will be done using sterile technique and techniques to prevent blood loss and the insertion of air bubbles into the infant.Equipment:• Syringe with 1-2 cc sterile saline for IV use without preservatives• Sterile syringes (unused without needle); one for aspirate and one for specimen• Appropriate blood collection tubes(contact lab for tube type/amount of specimen needed)
Procedure:1. Obtain physician order for procedure.2. If infant has a UAC and a UVC, the blood gases should be drawn from the UAC; noting the source of the specimen in ordering, reporting, and charting.3. Order the appropriate tests in CPSI using the Ancillary Screen.4. Notify Lab and/or Cardiopulmonary of order. For ABGs, have Cardiopulmonary at bedside before drawing blood to take specimen.
5. Turn stopcock so that the IV solution stops flowing.6. Aspirate 1-2 ml. from catheter into a dry syringe to clear the catheter of IV fluids. This syringe must remain sterile after aspirating, as this will be reinserted.7. Turn the stopcock to the neutral position, remove the syringe, and replace it with appropriate collection syringe. ***The neutral position of the stopcock prevents contaminating the sample with IV fluid and prevents blood loss from the infant.****Caution: Never allow blood to drip from an open stopcock.
8. Aspirate approximately 0.25 cc blood into heparinized syringe for blood gasses or indicated amount in a regular syringe for other collection. (Notify Lab for amounts & tubes for other specimens prior to collecting)9. Turn the stopcock to the neutral position and remove the syringe. Remove the air from the syringe and cap. (Cardiopulmonary will take the specimen to run the gases)10. Remove any air bubbles from the original aspirated blood syringe. Turn off the stopcock to the IV.11. Slightly aspirate to remove any air in the stopcock, hold syringe up so air rises to the top and inject the blood slowly, watching carefully for any evidence of air bubbles.
12.Return the stopcock to the neutral position.13.Replace the fresh syringe filled with 2 cc NS flush solution & inject enough solution to remove blood from line.14.Turn the stopcock so the IV fluids can be infused and restart infusion pump.15.Clean stopcock of any blood on it.16.Document the blood collection.
17. Record the amount of blood removed from the infant and the amount of flush used on the computer screen for intake/output.18.Reassess the infant’s color, temperature, perfusion, and pulses of lower extremities following the procedure. Note changes from previous assessment.
19. Observe for arterial spasm and emboli. Symptoms are as follows: • White, blue, or black discoloration of the skin If symptoms for arterial spasm or emboli occur, perform the following: • Notify physician • Monitor the back, buttocks, legs, feet, and toes • Assess lower extremity pulses • Prepare for the removal of the umbilical line20. When one of the lumens of the catheter is not in use, flush the un-used lumen every 6-8 hours with 2ccs of sodium chloride flush. Use positive pressure when flushing to eliminate the potential of blood migration into the catheter.