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The page below is a sample from the LabCE course Special Topics in Phlebotomy. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Collection from a Vascular Access Device (VAD)

Vascular access devices (VAD) include a variety of infusion catheters and ports. The most common device is one that is inserted in the arm or hand and used to provide easy access to a patient's circulatory system for administration of fluids and medications. Occasionally, blood specimens are drawn from a VAD, if a direct venipuncture is not feasible; however, the potential for specimen hemolysis or contamination with fluids or medications is increased when a specimen is collected from a VAD. Phlebotomists are not usually authorized to collect these specimens unless they have completed thorough and documented training. However, phlebotomists may sometimes assist when a clinical person who has been properly trained is collecting blood from a VAD. If you are present, be certain that the person performing the collection flushes the line properly (according to facility and manufacturer's guidelines) to avoid contamination and/or dilution of the specimen. The Clinical and Laboratory Standards Institute (CLSI) recommends this procedure:
  1. If a specimen is collected for drug levels, the specimen must be collected from a catheter lumen not being used for infusion of the same drug. Withdraw a discard amount equal to two times the dead-space volume for noncoagulation testing. When drawing coagulation studies from a catheter lumen in which anticoagulation therapy had been infusing, withdraw six times the dead-space volume. As a general guideline, 5 mL of blood may be a sufficient discard volume for the majority of central lines; however, some central lines require up to 11 mL as a discard volume. Knowing the dead-space volume when drawing coagulation studies is important to ensure accurate coagulation results. If drawing directly into tubes, use a plain, nonadditive tube or a tube of the same type as the first tube (This tube will be discarded).
  2. Obtain the specimen. If the specimen was obtained using a syringe, a safety transfer device must be used to transfer the specimen into the blood collection tube(s); a needle must not be used.
  3. Flush the VAD following facility and manufacturer's guidelines.
  4. Make a notation in the patient record that the specimen was collected through a VAD.

Clinical and Laboratory Standards Institute (CLSI). Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI document GP41. Wayne, PA: CLSI: 2017.