I work in Complex Continuing Care and clients are admitted to our institution with Port-o-Cath inserted prior for diffrent treatments ex cancer treatment...
Shoul we need blood work can we continue using Port-o- Caths only for blood work?
What is the best practice?

I too have this question. What is the best practise? Major center near us has stopped using CVAD for blood draw. We are looking at changing our practise. Does anyone have any evidence that might be used to decide about change in practise.

Thanks
Linda

Hi Linda & Ankica,
We know that blood sampling is an indicator for CVAD placement. However, the RNAO BPG's (published in 2005) recommend minimizing blood sampling when frequent blood sampling is indicated (no definition for "frequent blood sampling"), to prevent nosocomial blood loss and prevent infection.

The INS Standards (2011) take a more temperate position, indicating that a risk/benefit analysis should be considered (Benefits: "avoidance of anxiety, discomfort and dissatisfaction associated with venipuncture in patients who require frequent blood tests and/0r those with difficult vascular access"; Risks:" increased risk for occlusion and catheter-related bloodstream infection due to increased hub manipulation and potetntial for inaccurate lab results, although there was no significate increase in occlusion, infection, or other complications in PICCs used for blood sampling in one study").

Numerous centers are going to reducing blood sampling via CVADs or opting for a more patient-centered approach leaving it to patient decision-making. The latter is my personal preference especially if a patient information sheet describing the risks and benefits is provided to facilitate informed decision-making.

(References for both published recommendations are below.)

Regards,
Daphne Broadhrust
Clinical Specialist
Desjardins Pharmacy

RNAO references:
Gorski, L., & Czaplewski, L. M. (2004). Peripherally inserted catheters and midline catheters for the home care nurse. Home Health Care Nurse, 22(11), 758-771.
Haire, W. D., & Herbst, S. F. (2000). Consensus conference on the use of alteplase (t-PA) for the management of thrombotic
catheter dysfunction. Journal of Vascular Access Devices, 5(2), 28–35.
Krzywda, E. A. (1998). Central venous access – catheters, technology, and philosophy. MEDSURG Nursing, 7(3), 132-141.

INS References:
Mahieu LM et al. Catehter manipulations & the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients. J Hosp Infect. 2001;48(1):20-26.
Frey AM. Drawing blod samples from vascular access devices: evidence-based practice. J Infus Nurs. 2003;26(5):30-35.
Knue M et al. The efficacy & safety of blood sampling through peripherally inserted central catheter devices in children. J Infus Nurs. 2005:28(1):30-35.

Came into work & found the Oncology Nursing Society Access Device Guidelines (2011)had arrived and was sitting on my desk this am. (Thank you Easter Bunny.) This authoritative document briefly describes the procedure to draw blood samples from CVADs, including implanted ports. In my quick perusal of the document, I don't see a precaution against this procedure. It's not listed in the risk factors or prevention techniques for either catheter occlusions or infection. Will have a closer look at it tonight and reprot back if there's anything else.
Daphne Broadhurst
Desjardins Pharmacy
Ottawa ON