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Real Nursing Skills 2.

0 Administering Intravenous Therapy: Accessing a Central Venous Catheter Purpose To withdraw a blood specimen from a central venous catheter Delegation Accessing a central venous catheter is a skill designated specifically for licensed medical personnel only (Registered Nurses or Licensed Practical Nurses)* *Always check agency policy and applicable scope of practice Preparation

Consult hospital or institution procedure manual or other references for more detailed and specific information when needed Identify child and introduce self; use at least two client identifiers when providing care, treatment, or services Explain all procedures or treatments to child and parents Provide for client privacy Perform hand hygiene and adhere to standard precautions Prepare equipment: o Clean examination gloves o Sterile 4 x 4 gauze pad o Chlorhexidine or Povidone-iodine solution o Cotton-tipped swabs o Appropriate blood collection tubes o 19- to 27-gauge needles for transferring blood to tubes or needleless system per agency policy o Padded clamp (if a clamp is not attached to tubing) or clamps without teeth o Blood transfer set o For each port accessed: Syringe filled with 5 to 6 mL of normal saline Syringe filled with 20 mL normal saline Syringe filled with 2 to 3 mL of heparin flush solution 5- to 6-mL empty syringe (to draw and discard initial blood) Syringes for blood samples o Luer-lock or Broviac catheter cap solution (10 units/mL) o Some institutions may require a mask to be worn by the nurse, child, or family member

Pediatric Nursing Skills - 2012 Pearson Education, Inc.

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Real Nursing Skills 2.0 Post-Procedure

Keep samples at proper temperature and transport to the laboratory Assess childs response to procedure Tell child to indicate any discomfort (these instructions should be given before, during, and after procedure); if child is too young to verbalize discomfort, observe for signs or cues of discomfort Provide any instructions for child Clean work area and provide for client comfort Perform hand hygiene and adhere to standard precautions

Expected Outcome Specimen will be obtained and central venous catheter will remain patent Unexpected Outcome Child will be unable to cooperate with procedure Specimen will not be collected Ports of central venous catheter will be clotted off Documentation Ensure that blood specimens are labeled properly, per agency policy Document: o Quantity of blood withdrawn o Specific type of blood that the lab collected o Condition and patency of catheter and site Sample Documentation 0910: CBC ordered to be obtained from childs central venous catheter. Procedure explained to child and parent at bedside. Supplies necessary for procedure collected and placed at childs bedside. Port to be used for blood sampling cleansed with chlorhexadine and allowed to air dry. Line flushed with 20 mL of normal saline solution, discard syringe obtained and put aside, then the 3 mL of blood for specimen syringe obtained, then line flushed with normal saline and heparin solution via turbulent flush method. Blood collected for specimen distributed properly in the tube for CBC testing. Blood specimen labeled at childs bedside then placed in a biohazard bag and sent to the laboratory. Work area cleaned. Child tolerated entire procedure well. N. Nurse, RN. Resources and References Ball, J.W., Bindler, R. C. & Cowen, K. J. (2010). Child health nursing: Partnering with children and families (2nd ed). Upper Saddle River, NJ: Pearson Education, Inc. Binder, R. C. & Ball, J. W. (2008). Clinical skills manual for pediatric nursing: Caring for children (4th ed). Upper Saddle River, NJ: Pearson Education, Inc. Pediatric Nursing Skills - 2012 Pearson Education, Inc. Page 2 of 3

Real Nursing Skills 2.0 Wilson, D. & Hockenberry, M. J. (2008). Wongs clinical manual of pediatric nursing (7th ed). St. Louis, MI: Mosby Elsevier.

Pediatric Nursing Skills - 2012 Pearson Education, Inc.

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