Approved by: Gail Cameron Senior Director Operations, Women s and Child Health Dr. Byrne Medical Director, Neonatology Blood Sampling: Arterial Lines Neonatal Nursery Policy & Procedures Manual : Date Effective November, 2016 Next Review November, 2019 Dr. Shaik Medical Director, Neonatology Purpose Procedure To ensure safe sampling of blood from both peripheral and central arterial lines. Equipment Three ml syringes Heparinized syringe (if blood gas required) Blunt cannulas Appropriate blood specimen tubes Antiseptic swabs Arterial flush solution or prepackaged syringe flushes Umbilical Arterial Lines ACTION 1. Perform hand hygiene, gather equipment, and don gloves. RATIONALE Standard precautions. 2. Obtain arterial line flush solution. To flush the line following blood withdrawal. Refer to the Heparin Use Policy for recommended guidelines. 3. Silence ECG monitor alarms for a line with monitored BP. 4. Close the distal valve by turning the handle perpendicular to the tubing. IV solution and heparin contaminate the blood samples. Distal Valve Perpendicular to line
Page 2 of 6 5. Smoothly and evenly pull up on the reservoir plunger to draw approximately 1 1.5 ml of clearing volume assessing when pure blood is at the sampling site. Recommended pull rate is 1 ml every 10-15 seconds. Volume of draw removed will depend on the volume in the particular line used. Quick withdrawal of blood may result in spasm of the artery. 6. Close the proximal shut-off valve by turning the handle perpendicular to tubing to minimize contamination of the sample by infusion fluid. 7. Swab proximal sample site. Ensure plunger is depressed to the bottom of the sampling syringe. Insert syringe with blunt end cannula into proximal sampling site.
Page 3 of 6 8. Slowly draw blood sample as required. Recommended pull rate is 1 ml every 10-15 seconds.draw lab work first and then a blood gas sample. 9. Remove syringe from the sampling site by pulling straight out. Obtain assistance for placement of blood into containers if this will take more than one minute because stationary blood in the line may result in clot formation. Stationary blood should remain in Vamp Jr. for no longer than 3 minutes. For Blood gas samples, remove the blunt cannula, apply a stopper and expel any air. 10. Open the proximal valve by turning handle parallel to the tubing.
Page 4 of 6 11. Return the clearing volume by slowly, smoothly and evenly pushing down on the plunger of the Vamp Jr. until it is fully closed. Recommended return rate is 1 ml every 10-15 seconds. Infusing too rapidly or using excessive volumes can cause arteriospasm and subsequent complications. This is particularly true of peripheral arterial lines. 12. Ensure the flush syringe is free of air. Swab distal access port. Insert syringe with the blunt cannula into the distal access port. Slowly flush the line just until the blood is cleared from the line. The Vamp Jr. may need to be held down during this step so that the flush does not pool in the reservoir. Open the distal valve. 13. Activate monitor alarms. 14. Check position of the valves, and ensure connections are tight. No blood should back-up into the line. 15. Decant blood specimens into appropriate specimen tubes. 16. Record blood withdrawal procedure on
Page 5 of 6 the patient care record. Related Documents Adapted with permission from Stollery Children s Policy and Procedure Manual: http://insite.albertahealthservices.ca/assets/policy/clp-capital-nicu-pp-cardiovascular-blood-sampling-artline-pro.pdf Blood Sampling Arterial Lines, 2013 RELATED POLICIES AND PROCEDURES Heparin Use Blood Pressure Monitoring: Arterial Lines References Product detail and user guide video https://www.youtube.com/watch?v=fyryhs29va8 Revisions July 2005 December 2009 Inservice Bulletin http://ht.edwards.com/resourcegallery/products/pressuremonitoring/pdfs/1158vampjrinsvc.pdf
Page 6 of 6 Signing Original Signed GAIL CAMERON SENIOR DIRECTOR OPERATIONS WOMEN S & CHILD HEALTH COVENANT HEALTH GREY NUNS & MISERCORDIA HOSPITALS Original Signed DR. PAUL BYRNE MEDICAL DIRECTOR NEONATAL PROGRAM COVENANT HEALTH GREY NUNS HOSPITAL November, 2016 DATE December, 2016 DATE Original Signed November, December, 2016 2016 DR. SHARIF SHAIK DATE MEDICAL DIRECTOR NEONATAL PROGRAM COVENANT HEALTH MISERCORDIA HOSPITAL