The purpose of this study was to test agreement in blood values obtained from a discard method and a push-pull method in samples from central venous catheters in pediatric patients. The discard method causes blood loss beyond what is necessary for blood testing and increases potential for infection each time the central venous catheter is entered. Twenty-eight children ranging in age from 6 months to 12 years were enrolled in the study. A research protocol was developed to pair the 2 methods of blood collection for each sample. The Bland-Altman method was used to test agreement on each blood value for each paired sample. Of the 438 pairs of measured blood values, 420 (95.9%) fell within the limits of agreement. Nurses reported no difficulty in using the push-pull technique to obtain any samples. The push-pull method of obtaining blood specimens from pediatric central venous catheters should be considered. It can eliminate blood loss through discard and can reduce infection because it reduces the number of times a catheter is entered.

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74chronic conditions and the 51 fathers of well children who participated each completed the Hymovich Family Perception Inventory (FPI) anonymously. The Hymovich instrument contains nine scales. Descriptive statistics and single tailed t tests were used to analyze the data.The results revealed significant differences in the parenting concerns of fathers of children with chronic conditions and fathers of well children. These concerns center around their children's health and include the need for knowledge. Fathers of children with chronic conditions also reported significant differences in the parenting concerns of their wives but with strong correlations to their own concerns. There are indications that there is a place for professional anticipatory guidance, dissemination of information, and encouragement in the use of fathers' informal support systems to provide the kinds of support needed by fathers of children with chronic conditions. The purpose of this study was to compare laboratory values for blood obtained using the push-pull method from a central venous catheter (CVC) with those obtained using the discard method. Discard is necessary to reduce error in lab values due to saline and heparin in the line proximal to the point where the sample is aspirated. The push-pull method consists of aspirating a blood sample, reinfusing it, aspirating again, reinfusing, then aspirating a sample for lab analysis. If the push-pull method provides lab values statistically similar to the discard method, the discard method can be discontinued, thus eliminating unnecessary blood loss and reducing the number of times the line is entered. A majority of children with cancer have a CVC placed early in treatment. In a survey of 34 pediatric bone marrow units, Keller (1994) found a majority using the discard method with discard volumes ranging from 0.5 cc to 10 cc. Keller (1994) reported procedures for obtaining blood samples were rarely research based. One study in adults (Holmes, 1998) found no difference in lab values between samples drawn using the discard and the pushpull method. After obtaining IRB approval, consent, and assent, 25 paired samples were obtained. Results were analyzed using t tests and the Bland-Altman statistical test to determine differences in lab values for CBC and differential, electrolytes, glucose, and selected drug levels. Results will be available in the conference presentation. This study allows clinical decision making related to CVC procedures to be evidence-based. If the two methods prove statistically similar, blood discard can be eliminated, reducing blood loss and a potential source of infection in children with cancer.References Holmes, K. (1998). Comparison of push-pull versus discard method from central venous catheters for blood testing.