From the Guidelines
Yes, blood samples can be drawn from a hemodialysis (HD) catheter, but this should generally be done only when other venous access options are unavailable. When drawing labs from an HD catheter, strict aseptic technique must be followed to prevent infection, as emphasized by the Infectious Diseases Society of America in their 2009 guidelines 1. The procedure typically involves discarding 5-10 mL of blood as waste before collecting the sample to avoid dilution from the catheter lock solution (typically heparin or citrate), a recommendation supported by the NKF-K/DOQI clinical practice guidelines for hemodialysis adequacy update 2000 1. After collection, the catheter must be flushed with normal saline and then relocked with the appropriate solution according to protocol.
Key Considerations
- The risk of catheter-related bloodstream infections is a significant concern when drawing blood from an HD catheter, as highlighted in the 2009 update by the Infectious Diseases Society of America 1.
- Catheter dysfunction and potential blood loss over time are additional risks associated with frequent draws from an HD catheter.
- Some laboratory values, particularly coagulation studies, may be affected by the catheter lock solution, such as heparin 1.
- Peripheral venipuncture remains the preferred method for obtaining blood samples when possible, with HD catheter draws reserved for situations where peripheral access is extremely difficult or impossible, as suggested by the guidelines 1.
Best Practices
- Follow strict aseptic technique to minimize the risk of infection.
- Discard the appropriate amount of blood (5-10 mL for adults, 3-5 mL for pediatric patients) before collecting the sample to avoid dilution from the catheter lock solution.
- Flush the catheter with normal saline and relock with the appropriate solution after collection.
- Reserve HD catheter draws for situations where peripheral access is not feasible.
From the Research
Drawing Labs from HD Catheter
- There is no direct evidence to suggest that labs can be drawn from an HD catheter 2, 3, 4, 5, 6.
- The provided studies focus on the prevention, diagnosis, and treatment of catheter-related infections in HD patients, as well as the management of CRBSIs in patients receiving maintenance HD through a permanent CVC 2, 4, 5, 6.
- However, it is implied that HD catheters are used for dialysis and not typically for drawing labs, as the studies discuss catheter care, management, and complications related to dialysis 3, 4, 6.
- The use of HD catheters for lab draws is not explicitly mentioned in the provided studies, suggesting that it may not be a common or recommended practice 2, 3, 4, 5, 6.