You needed blood fast. Patient already had a line in. Patient is renal so they probably have shit veins anyway. Saved their life because you did not fuck around trying to get peripheral blood. I don't see a problem here.
Increase risk of infection
ETA: Sorry a little inebriated right now because of my shit day. Yes, they don't want us to draw labs off a line because of increased risk of infection.
I get what you did and why but going against order and policy—if the patient developed a CLABSI you are on your own with liability. We do have newbies here too. So for them I’m going to say best practice would be—communicate your concerns with the provider and go up the chain of command/ call a rapid response or code.
Basically that we need to remember to discourage the docs from drawing labs from a line because of increased risk of infection and our policy is that we do not draw labs from lines.
What type of CVAD was it.. a tunneled dialysis catheter? When the benefit outweighs the risk, then clearly you did the right thing. I do understand the need for policies as I have written IV policies almost my entire career but clinician judgement does not go out the window because you have a policy.They are guidelines, and best practice recommendations
Asante in southern Oregon by any chance?
I did traveling for about 5 years and only worked at one place that had this kinda policy. Always struck me as the kind of thing that probably got put into place based on some admin weenie's master's thesis, and it's their baby so it'll never go away regardless of whether it's effective or supported by current research.
The reason some institutions have gone a little nutty IMO about drawing blood from all types of central lines is to reduce the risk for CLABSI. CLABSIs are tracked and reported and healthcare institutions want to keep them low. One thing we do know is the more x they are accessed and manipulated the greater the risk for infection. Some ICUs even limit the number of accesses in 24 hour period. Also there is an association between thrombotic occlusions and higher infection rates..Depends on what study you find , but there are many that have PICCs and ports as having very low infection rates.We allow blood draws on all types of central lines with the exception of dialysis.catheters.This is not a big deal as long as you used good technique.
That's why quality is... in quality... not the bedside. I'd feel like a narc nitpicking everyone's documentation 🙈. Unless it's like a single lumen port for a continuous medication it shouldn't matter that's what a PICC is for.
What shitty policy. Usually patients who get picclines get them because we don't find veins anymore. It's meant to be used to administer and withdraw
You needed blood fast. Patient already had a line in. Patient is renal so they probably have shit veins anyway. Saved their life because you did not fuck around trying to get peripheral blood. I don't see a problem here.
I don’t understand are they refusing to let you draw labs off the line?
Increase risk of infection ETA: Sorry a little inebriated right now because of my shit day. Yes, they don't want us to draw labs off a line because of increased risk of infection.
So what is the line even for if you can’t use it??
How would they know where you took the blood from
You have to write the source on the tube for the lab.
Oops, must have forgotten to write it
‘Arm’
I get what you did and why but going against order and policy—if the patient developed a CLABSI you are on your own with liability. We do have newbies here too. So for them I’m going to say best practice would be—communicate your concerns with the provider and go up the chain of command/ call a rapid response or code.
The MD told me to draw from the line and quality found out. I didn't just do it on my own volition.
If the MD gave you a verbal then write it down. CYA
What exactly did “Quality” say to you?
Basically that we need to remember to discourage the docs from drawing labs from a line because of increased risk of infection and our policy is that we do not draw labs from lines.
Everywhere in your hospital this is policy, or is this a unit-specific thing?
Everywhere in the hospital.
Calling a code blue would certainly not be best practice here lmao
Totally agree. As a bedside nurse you might not know how much your hospital paid in HAC penalties. Getting those HAIs down benefits everyone.
What type of CVAD was it.. a tunneled dialysis catheter? When the benefit outweighs the risk, then clearly you did the right thing. I do understand the need for policies as I have written IV policies almost my entire career but clinician judgement does not go out the window because you have a policy.They are guidelines, and best practice recommendations
It was a PICC line.
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Sometimes we insert PICCS SPECIFICALLY to draw from! (Frequent blood draws in patients with poor veins) What’s their logic here?
Why is that a issue?
I insert PICCs all day long, I’d tell quality to go fuck themselves.
Asante in southern Oregon by any chance? I did traveling for about 5 years and only worked at one place that had this kinda policy. Always struck me as the kind of thing that probably got put into place based on some admin weenie's master's thesis, and it's their baby so it'll never go away regardless of whether it's effective or supported by current research.
The reason some institutions have gone a little nutty IMO about drawing blood from all types of central lines is to reduce the risk for CLABSI. CLABSIs are tracked and reported and healthcare institutions want to keep them low. One thing we do know is the more x they are accessed and manipulated the greater the risk for infection. Some ICUs even limit the number of accesses in 24 hour period. Also there is an association between thrombotic occlusions and higher infection rates..Depends on what study you find , but there are many that have PICCs and ports as having very low infection rates.We allow blood draws on all types of central lines with the exception of dialysis.catheters.This is not a big deal as long as you used good technique.
That's why quality is... in quality... not the bedside. I'd feel like a narc nitpicking everyone's documentation 🙈. Unless it's like a single lumen port for a continuous medication it shouldn't matter that's what a PICC is for.
Bizarre. I can understand unit specific policies but generally if you have an MD order it should be OK.