1. Introduction Continuous heparin infusions require monitoring of aPTT values and appropriate adjustments in the infusion rate. If the heparin is infusing through the central venous access devices (CVAD), how should aPTTs be collected? Peripheral required/desired? From CVAD acceptable? Turn off infusion? Flush first? Waste amount? Desired port? For patients with central venous access devices (CVAD), blood samples may be collected from the CVAD or from a peripheral vein. Comparison of aPTT values from venipuncture and central venous access device specimens in hospitalized adult patients receiving continuous heparin infusions Mary Sue Dailey, APN- CNS, Fortunata Dabu, RN, BSN, Sue Durkin, APN- CNS, Barbara Gulczynski, APN- CNS, NP, Colleen O’Leary, APN-CNS, Carrie Bauman, RN, BSN, Karen Calimlim, RN, BSN, Karen Hagemaster, RN, BSN, Joy Kennedy, RN, BSN, Barbara Kohn, MTRN, BSN, Comparison of aPTT values from venipuncture and central venous access device specimens in hospitalized adult patients receiving continuous heparin infusions Mary Sue Dailey, APN- CNS, Fortunata Dabu, RN, BSN, Sue Durkin, APN- CNS, Barbara Gulczynski, APN- CNS, NP, Colleen O’Leary, APN-CNS, Carrie Bauman, RN, BSN, Karen Calimlim, RN, BSN, Karen Hagemaster, RN, BSN, Joy Kennedy, RN, BSN, Barbara Kohn, MTRN, BSN, Selected References Preliminary Results Paired blood specimen results compared 62% of specimens correlate within 10% Further data analysis concerning type of line, concurrent infusions, and other clinical variables will be performed Previous Studies Venipuncture vs Peripheral VAD Powers (1999) n=32 Prue-Owens (2006) n=23 Venipuncture vs Arterial Line Alzetani (2004) n=49 Heap (1997) n=79 Venipuncture vs CVAD Bellmunt. P, et al. (2000) n=74 Humphries and Baldwin (2009) n=30. Discrepancies Nursing and Lab Policies Previous Studies Actual RN Practice Manufacturers Guidelines Professional Standards Policies Lab Turn off infusion Waste depends on dead spaces : 5-12mL Coags first Nursing Does not mention stopping infusion first No mention of “desired port” Waste first 6 mL No guidelines regarding order of tube fill Professional Standards Infusion Nursing Society (2006) Stop infusion Flush with 3-5 mL Distal lumen preferred Discard volume equal to 1.5-2 times the fill volume of the CVAD Manufacturer’s Guidelines Arrow (TLC) Use proximal port Turn off distal infusions for at least one minute Discard volume varies from priming volume (dead space) to 3-10mL Bard (PICC) Flush per hospital protocol Waste 2-6 X the priming volume 5mL = 6x the priming volume of all non-tunneled PICC Study Design Paired blood samples from 80 patients receiving a continuous heparin infusion through a CVAD will be collected by a research RN and a lab phlebotomist CVAD specimen Peripheral Venous specimen Need 74 subjects (37 in each group) to detect a 2 second difference between specimens (SD 3 seconds) Power of.80 and alpha=.05 Clinical environment and demographic data collected Further Data Analysis Comparison of paired blood specimen results, screening for outliers, and unexpected variations Further review of Clinical Environment and Demographic data to be done, including analysis of trends per individual research RN Following data verification, descriptive statistics will be generated Obstacles and Solutions Actual RN practice 134 respondents completed online survey 82% flush prior to obtaining sample 50% waste 10 mL 56% collected coag specimen first 94% stop infusion Range of % Difference of Lab Draw aPTT and RN aPTT Purpose of Study Is there a clinically significant difference between the aPTT results from a specimen collected from CVAD and a specimen collected from a peripheral vein? Patient Consent- Many critically ill Patient/ Family reluctant/unwilling to be “stuck” Concurrent focus on central line necessity Reports generated early AM- patient condition changes Research RN coverage Bellmunt. P., et al. (2000). Sample extraction through central venous catheters to control partial thromboplastin time in patients undergoing heparin sodium perfusion. Enfermeria Intensiva 11(4), 155-60. Humphries, L., & Baldwin, K. (2009). A study comparing test results from PICCs and veinipunctures. Poster presentation at National Association of Clinical Nurse Specialists Annual Conference. ATTENTION PHLEBOTOM IST: PLEASE SEE RN BEFORE ____BLOOD DRAW THANKS FROM THE RESEARCH TEAM