A reliable and safe method of collecting blood samples from implantable central venous catheters for determination of plasma gentamicin concentrations

Comparison of laboratory results between central venous access devices and venipuncture: A systematic review and meta-analysis

OBJECTIVES

To compare the hematologic, blood chemistry, and coagulation test results between two blood sampling methods via central venous access devices (CVADs) and venipuncture.

METHOD

The authors searched PubMed, Embase, Cochrane, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for controlled studies that compared the differences in hematologic, blood chemistry, and coagulation test results between venipuncture and CVADs from the date of database establishment to July 2022. Two researchers independently performed the literature screening, data extraction, and quality assessment. The standardized mean difference was used as the effect size for continuous variables and a 95% confidence interval was provided. The random-effects model was used for an I2 > 50%, otherwise the fixed-effects model was used. Sources of heterogeneity were determined by subgroup analysis or sensitivity analysis, as indicated.

RESULTS

This review ultimately identified 17 studies for systematic review, of which 12 were selected for meta-analysis. A total of 541 adult participants were included in the meta-analysis. With the exception of the activated partial thromboplastin time, there were no significant differences in hematologic, blood chemistry, and coagulation test results between blood sampling via venipuncture and CVADs.

CONCLUSIONS

The results of this study provide substantial evidence that blood sampling via venipuncture and CVADs had equal reliability in most laboratory tests. Serial blood sampling via CVADs will reduce the risk of bleeding episodes and pain at the blood collection site, and safety for healthcare professionals.

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

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.

Blood sampling from peripherally inserted central catheter is effective and safe for patients with head and neck cancers

OBJECTIVE

To evaluate the validity of laboratory tests for blood sampling from a peripherally inserted central catheter.

METHODS

A total of 22 patients diagnosed with head and neck cancers were enrolled. In total, 101 paired blood samples were taken both via venipuncture and peripherally inserted central catheter for hematology and biochemistry testing. Paired t tests and linear correlation analysis were used to evaluate the results. Blood sampling-related pain was recorded by visual analogue scales and numerical rating scales. Infusion occlusion, hemolysis, and catheter-related blood stream infection were also recorded.

RESULTS

The peripherally inserted central catheter-associated test results were slightly lower than those with venipuncture. Some parameters differed more than others. However, the degree of difference was less than 5% for every pair. There was a high correlation between the test results with two methods of blood sampling with the representative equation approximately being "y = x." According to visual analogue scales and numerical rating scale analysis, the pain degree with peripherally inserted central catheter was significantly lower than that of the venipuncture (p < 0.001). No case of infusion occlusion, catheter-related blood stream infection was reported with both methods. Hemolysis rate in blood samples from peripherally inserted central catheter (1/101) was much lower than that seen with venipuncture (11/101) with significant difference (p = 0.0056).

CONCLUSION

Blood sampling via peripherally inserted central catheter and venipuncture showed equivalent reliability in laboratory testing. Compared with venipuncture, blood sampling via peripherally inserted central catheter causes less pain and is safer. Blood sampling via peripherally inserted central catheter is strongly recommended for clinical use.

A Standard Push-Pull Protocol for Waste-Free Sampling in the Pediatric Intensive Care Unit

Blood sampling is a major source of blood loss in the pediatric intensive care unit (PICU). Blood-sparing sampling techniques such as the push-pull method can significantly reduce sampling-related blood loss and protect patients from anemia and blood transfusions. The push-pull method is supported by research evidence for central venous catheter (CVC) sampling, but research protocols differ and not all CVCs and laboratory tests have been studied. A standard push-pull protocol for the PICU was developed, implemented, and evaluated in this evidence-based practice project. Results show that the protocol can be used safely and reliably as a standard waste-free sampling method in the PICU.

Comparing the Push-Pull Versus Discard Blood Sample Method From Adult Central Vascular Access Devices

This study demonstrates the feasibility of replacing the discard blood sampling method for central vascular access devices with the push-pull method. A comparative, within-subject design was used to evaluate 61 unique, paired blood samples from 1 adult outpatient oncology clinic. A 21-measure laboratory panel was conducted on each of the paired samples. Interpretation showed a small mean bias and excellent agreement between the methods. Blood samples obtained using the push-pull method were within clinically acceptable ranges. No hemolysis was noted by laboratory evaluation of 59 samples.