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

The project was a small, single-site convenience sample of 37 patients and 88 draws, so it cannot prove the method is safe for all pediatric central lines. Push-pull and standard samples were not drawn at the same time; comparisons were usually within 12 to 24 hours, during which critically ill patients can change. Laboratory values were compared with standard central line draws, not peripheral venipuncture, so the method was not tested against the gold standard. Catheter complications could not be separated from standard sampling because both methods were used on the same patients and catheters. Some tests had too few samples for statistical analysis, and several samples were excluded for errors or contamination. Blood return from 2.6 Fr PICCs was sometimes difficult and prevented one push-pull draw, so very small catheters may not be suitable. Coagulation tests were drawn from heparinized catheters, which remains controversial and was compared only to standard CVC draws.

The authors reported no conflicts of interest. The project was exempt from Institutional Review Board oversight.

Do not read this as proof that push-pull sampling prevents catheter occlusion or infection for all pediatric central lines. It was a small single-site evidence-based practice project, both push-pull and standard sampling were used, and 8 withdrawal occlusions occurred within 7 days.