Methods of drawing blood samples through central venous catheters in pediatric patients undergoing bone marrow transplant: results of a national survey.

PURPOSE/OBJECTIVES: To describe methods of drawing blood samples from central venous catheters (CVCs) currently in use in pediatric bone marrow transplant (BMT) units, the rationale for method selection, and concerns of clinicians related to those methods.

DESIGN

Descriptive survey.

SETTING

National.

SAMPLE

34 pediatric BMT units (median = 8 beds) in hospitals ranging in size from 48 to 1,100 beds (median = 530).

METHODS

A mailed questionnaire was completed by a designated member of the BMT nursing staff.

MAIN RESEARCH VARIABLES

Type of blood drawing method, volume of blood drawn, rationale for using a specific method and volume, and clinician concerns regarding drawing procedure.

FINDINGS

The majority of the BMT units use the discard method of blood drawing (i.e., prior to drawing the required volume of blood for testing, a sample of blood is withdrawn and discarded). Discard volumes ranged from 0.5 ml-10 ml. The most frequently cited concerns were risk of infection, blood loss, and accuracy of laboratory values.

CONCLUSIONS

The concerns of the respondents and the lack of empiric studies mandate that research determine the safest method of drawing blood samples through CVCs in a pediatric BMT population.

IMPLICATIONS FOR NURSING PRACTICE

Concern regarding current practice exists, but minimal data are available to assist nurses in determining safe and appropriate methods for withdrawing blood through CVCs. A prospective, randomized study of the three methods currently being used with a large sample can provide the information necessary to establish quality practice guidelines.