Johns Hopkins Nursing Evidence-Based Practice Thrid Edition: Model and Guidelines

(^228) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition

3

Drawing aPTT Samples from Central Lines While

Heparin Is Concurrently Infusing

Daniel Hare, BSN, RN, PCCN

Margaret Witman, RN, PCCN

Candice Penaranda, BSN, RN

Jennifer Mayo, BSN, RN

Christina Ewing, BSN, RN

Barbara Palm, RN

Nicole Bahadursingh, RN

Ashley Ewald, RN

Capucine Dingle, RN

Heidi Mock, RN

Tania Fletcher, BSN, RN

Karen Keim, MSN, RN

Heidi Chroszielewski, MSN, RN-BC, PCCN

Mercy Medical Center

Baltimore, Maryland, USA

Practice Question

The practice of drawing an activated partial thromboplastin time (aPTT) from

central lines while Heparin is concurrently infusing was inconsistent and not

defined for frontline nurses. Nurse interviews validated the lack of clarity, includ-

ing differences in the amount of time the Heparin was held prior to drawing the

aPTT sample, the amount of normal saline used to flush the line prior to drawing

the aPTT sample, and the amount of waste drawn prior to drawing the aPTT

sample. A community search utilizing local Magnet hospitals revealed similar

inconsistencies in nursing practice. An internal survey among clinical nurses was

conducted, and the lack of procedural clarity had similar findings. To standard-

ize practice, clinical nurses decided to implement an EBP process focusing on the