From Nancy Fabbrini: We have a patient on an argatroban bridge to warfarin. He is a very difficult draw so the service has been drawing blood from the central access device. They have been withdrawing 20 mL of blood before drawing the tube for coagulation testing. Is that sufficient, i.e. do the same “rules” for a line with heparin apply to argatroban? Thank you.
Hello, Nancy, and thank you for your question. The rule for all vascular access devices is that before blood is collected for hemostasis testing, the line must be flushed with 5 mL of saline, and the first 5 mL of blood, or six times the volume of the tube, must be collected and discarded. There is no distinction made for argatroban, and I’d be concerned that 20 mL seems excessive. Geo.
The standard that applies is Clinical and Laboratory Standards Institute: Procedures for the collection of diagnostic blood specimens by venipuncture: approved standard, ed 6, CLSI Document GP41-A6, Wayne, Pa, 2007, Clinical and Laboratory Standards Institute. I hope this is helpful for you.