Obtaining Coagulation Blood Samples From Central Venous Access Devices: A Review of the Literature

Dalton, Kerri A.; Aucoin, Julia; Meyer, Britt M.

doi:10.1188/15.cjon.19-04ap

Cited by 15 publications

(6 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…From systematic reviews of 11 studies [16], they find that sample sizes in each study were too small (N range from 12-53) (72 sample sizes in this study). Pearson correlations, or mean difference comparisons, may have statistical differences but cannot be interpreted as clinical judgment, making them difficult to apply in actual practice.…”

Section: Discussionmentioning

confidence: 75%

Accuracy of laboratory tests drawn by pull-push method from central venous catheterization after routine flushing with 10 ml normal saline in patients with sepsis at the emergency department

Lokeskrawee

Muengtaweepongsa

Patumanond

et al. 2021

Heliyon

View full text Add to dashboard Cite

Central venous catheterization (CVC) remains a common practice in the emergency setting. Routine flushing 10-20 ml of normal saline to maintain the patency of CVC could affect the accuracy of laboratory tests. Typically, physicians require peripheral vein phlebotomy when more blood sampling is needed. One alternative method, the Pull-push method, could avoid the trauma associated with venipuncture and unnecessary peripheral vein phlebotomy. However, there has been no recent study analyzing the accuracy of blood sampling using this technique. We evaluate laboratory tests' accuracy between blood samples drawn by the Pull-push method from CVC after routine flushing with 10 ml of normal saline versus control. We conducted a diagnostic accuracy study from May to September 2019. After exclusion, 72 patients were eligible for analysis. Promptly after central venous catheterization, we drew blood samples, stored them in blood collecting tubes, and labeled them for the gold standard group. We flushed with 10 ml of normal saline before blood sampling using the Pull-push method's completed three times; then, we drew blood samples again, labeled Pull-push group. We compared the laboratory results between two groups by paired t-test. The accuracies were analyzed based on an allowable error by Clinical Laboratory Improvement Amendments (CLIA) and presented by a modified Bland-Altman plot. The 72 patients were primarily male (n ¼ 47, 65.3%), had a mean age 60.1 AE 14.0 years, and were diagnosed with sepsis (n ¼ 4, 5.6%) or septic shock (n ¼ 65, 90.3%). For almost all the laboratory values, including hemoglobin, hematocrit, white blood cell count, platelet count, blood urea nitrogen, creatinine, sodium, potassium, chloride, bicarbonate, prothrombin time, international normalized ratio, and blood sugar, the accuracy was more than 90% (92.8-98.6%), except aPTT (85.5%) and aPTT ratio (86.7%). Laboratory tests drawn by the Pull-push method could replace peripheral vein phlebotomy to avoid the trauma associated with venipuncture and infection risk.

show abstract

Section: Discussionmentioning

confidence: 75%

Accuracy of laboratory tests drawn by pull-push method from central venous catheterization after routine flushing with 10 ml normal saline in patients with sepsis at the emergency department

Lokeskrawee

Muengtaweepongsa

Patumanond

et al. 2021

Heliyon

View full text Add to dashboard Cite

show abstract

“…From systematic reviews of 11 studies 16 , they nd that sample sizes in each study were too small (N range from 12-53) (72 sample sizes in this study). Pearson correlations, or mean difference comparisons, may have statistical differences but cannot be interpreted as clinical judgment, making them di cult to apply in real practice.…”

Section: The Accuracymentioning

confidence: 84%

Accuracy of Laboratory Tests Drawn by Pull-push Method from Central Venous Catheterization After Routine Flushing with 10 ml Normal Saline.

Lokeskrawee

Muengtaweepongsa

Sawaengrat

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Central venous catheterization (CVC) remains a common practice in the emergency setting. Routine flushing 10 - 20 ml of normal saline to maintain the patency of CVC could affect the accuracy of laboratory tests. Typically, physicians require peripheral vein phlebotomy when more blood sampling is needed. One of the alternative methods, the Pull-push method, could avoid too much pain and unnecessary peripheral vein phlebotomy. However, there has been no recent study analyzing the accuracy of blood sampling using this technique. Objective: We evaluate laboratory tests' accuracy between blood samples drawn by the Pull-push method from CVC after routine flushing with 10 ml of normal saline versus control. Methods: We conducted a diagnostic accuracy study from May to September 2019. After exclusion, 72 patients were eligible for analysis. Promptly after central venous catheterization, we drew blood samples, stored them in blood collecting tubes, and labeled them for the gold standard group. We flushed with 10 ml of normal saline before blood sampling using the Pull-push method's completed three times; then, we drew blood samples again, labeled Pull-push group. We compared the laboratory results between two groups by paired t-test. The accuracies were analyzed based on an allowable error by Clinical Laboratory Improvement Amendments (CLIA) and presented by a modified Bland-Altman plot. Results: The 72 patients were primarily male (n=47, 65.3%), had a mean age 60.1±14.0 years, and were diagnosed with sepsis (n=4, 5.6%) or septic shock (n=65, 90.3%). For almost all the laboratory values, including hemoglobin, hematocrit, white blood cell count, platelet count, blood urea nitrogen, creatinine, sodium, potassium, chloride, bicarbonate, prothrombin time, international normalized ratio, and blood sugar, the accuracy was more than 90% (92.8-98.6%), except aPTT (85.5%) and aPTT ratio (86.7%) Conclusion: Laboratory tests drawn by the Pull-push method could replace peripheral vein phlebotomy to avoid too much pain and infection risk.

show abstract

“…The existing literature has described the methods of blood sampling from a A comparative study on coagulation and hematologic laboratory techniques for blood sampling using the push-pull method from a CVC versus venipuncture CVAD, which mainly including the discard method, reinfusion method and push-pull method, and the discard method is the most common technique, however, when drawing blood specimens in this manner, an adequate volume of blood is usually discarded to avoid altering the test results because of the presence of infusion substances in the discarded sample. For the discard method, studies reported that discard volumes ranging from 2 to 25 mL, 2 and this wide variation could produce hospital-acquired anemia. 3,4 The reinfusion method is similar to the discard method, but the original discard sample is reinfused in the end.…”

Section: Introductionmentioning

confidence: 99%

A comparative study on coagulation and hematologic laboratory techniques for blood sampling using the push-pull method from a CVC versus venipuncture

et al. 2022

View full text Add to dashboard Cite

Objectives: To demonstrate the equivalence and substitutability of two blood collection methods: the push-pull method from a CVC and direct venous puncture (DVP). Methods: A comparative, within-subject study was conducted between September 2021 and December 2021 at a hospital in NanTong city. The sample comprised critically ill patients aged 18 and older in critical care units such as general, emergent, cardiac, respiratory, and neurological units. A total of 154 paired blood samples were collected via a CVC and direct venous puncture. This study focused on the laboratory results of the coagulation and hematologic tests. The reproducibility and reliability of the results were calculated by the mean of the coefficient of variation (CV) and the intraclass correlation coefficient (ICC). Bland–Altman statistics were used to analyze the substitutability of the two blood collection methods. Results: The difference in the means between the two methods ranged from −1.61 to 0.09, and the coefficients of variation for both methods were similar. The ICCs of the two methods were all above 0.90, which indicated excellent reliability. In the Bland–Altman plots, all of the blood samples that obtained by the push-pull method were within clinically acceptable ranges compared to the samples obtained by direct venous puncture. Conclusion: The push-pull method of collecting blood specimens from a CVC should be acceptable for coagulation and hematologic laboratory tests.

show abstract

Obtaining Coagulation Blood Samples From Central Venous Access Devices: A Review of the Literature

Cited by 15 publications

References 14 publications

Accuracy of laboratory tests drawn by pull-push method from central venous catheterization after routine flushing with 10 ml normal saline in patients with sepsis at the emergency department

Accuracy of laboratory tests drawn by pull-push method from central venous catheterization after routine flushing with 10 ml normal saline in patients with sepsis at the emergency department

Accuracy of Laboratory Tests Drawn by Pull-push Method from Central Venous Catheterization After Routine Flushing with 10 ml Normal Saline.

A comparative study on coagulation and hematologic laboratory techniques for blood sampling using the push-pull method from a CVC versus venipuncture

Contact Info

Product

Resources

About