1 / 1

Introduction

Comparison of aPTT values from venipuncture and central venous access device specimens in hospitalized adult patients receiving continuous heparin infusions Mary Sue Dailey, APN- CNS, Fortunata Dabu, RN, BSN, Sue Durkin, APN- CNS, Barbara Gulczynski, APN- CNS, NP,

lundy
Download Presentation

Introduction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Comparison of aPTT values from venipuncture and central venous access device specimens in hospitalized adult patients receiving continuous heparin infusions Mary Sue Dailey, APN- CNS, Fortunata Dabu, RN, BSN, Sue Durkin, APN- CNS, Barbara Gulczynski, APN- CNS, NP, Colleen O’Leary, APN-CNS, Carrie Bauman, RN, BSN, Karen Calimlim, RN, BSN, Karen Hagemaster, RN, BSN, Joy Kennedy, RN, BSN, Barbara Kohn, MTRN, BSN, • Introduction • Continuous heparin infusions require monitoring of aPTT values and appropriate adjustments in the infusion rate. • If the heparin is infusing through the central venous access devices (CVAD), how should aPTTs • be collected? • Peripheral required/desired? • From CVAD acceptable? • Turn off infusion? • Flush first? • Waste amount? • Desired port? • For patients with central venous access devices (CVAD), blood samples may be collected from the CVAD or from a peripheral vein. Discrepancies • Manufacturer’s Guidelines • Arrow (TLC) • Use proximal port • Turn off distal infusions for at least one minute • Discard volume varies from priming volume (dead space) • to 3-10mL • Bard (PICC) • Flush per hospital protocol • Waste 2-6 X the priming volume • 5mL = 6x the priming volume of all non-tunneled PICC • Preliminary Results • Paired blood specimen results compared • 62% of specimens correlate within 10% • Further data analysis concerning type of line, concurrent infusions, and other clinical variables will be performed Study Design Range of % Difference of Lab Draw aPTT and RN aPTT • Paired blood samples from 80 patients receiving a • continuous heparin infusion through a CVAD will be • collected by a research RN and a lab phlebotomist • CVAD specimen • Peripheral Venous specimen • Need 74 subjects (37 in each group) to detect a 2 second • difference between specimens (SD 3 seconds) • Power of .80 and alpha=.05 • Clinical environment and demographic data collected . • Policies • Lab • Turn off infusion • Waste depends on dead spaces : 5-12mL • Coags first • Nursing • Does not mention stopping infusion first • No mention of “desired port” • Waste first 6 mL • No guidelines regarding order of tube fill Further Data Analysis • Comparison of paired blood specimen results, screening for outliers, and unexpected variations • Further review of Clinical Environment and Demographic data to be done, including analysis of trends per individual research RN • Following data verification, descriptive statistics • will be generated • Purpose of Study • Is there a clinically significant difference between • the aPTT results from a specimen collected from • CVAD and a specimen collected from a peripheral • vein? Obstacles and Solutions Professional Standards • Previous Studies • Venipuncturevs Peripheral VAD • Powers (1999) n=32 • Prue-Owens (2006) n=23 • VenipuncturevsArterial Line • Alzetani (2004) n=49 • Heap (1997) n=79 • Venipuncturevs CVAD • Bellmunt. P, et al. (2000) n=74 • Humphries and Baldwin (2009) n=30 • Infusion Nursing Society (2006) • Stop infusion • Flush with 3-5 mL • Distal lumen preferred • Discard volume equal to 1.5-2 times the fill • volume of the CVAD • Patient Consent- Many critically ill • Patient/ Family reluctant/unwilling to be “stuck” • Concurrent focus on central line necessity • Reports generated early AM- patient condition changes • Research RN coverage Selected References • Bellmunt. P., et al. (2000). Sample extraction through central venous catheters to control partial thromboplastin time in patients undergoing heparin sodium perfusion. Enfermeria Intensiva 11(4), 155-60. • Humphries, L., & Baldwin, K. (2009). A study comparing test results from PICCs and veinipunctures. Poster presentation at National Association of Clinical Nurse Specialists Annual Conference. • Actual RN practice • 134 respondents completed online survey • 82% flush prior to obtaining sample • 50% waste 10 mL • 56% collected coag specimen first • 94% stop infusion ATTENTION PHLEBOTOMIST: PLEASE SEE RN BEFORE ____BLOOD DRAW THANKS FROM THE RESEARCH TEAM

More Related