CINAS: examples from clinical practice

Example 1

Injection is easy but when you try to get blood aspirated, there is only a little amount of pink coloured fluid in the extension set. You get brisk blood return after additional injection of flushing solution (0.9% Sodium Chloride) and asking the patient to change its chest, arm and/or head position. At the end you get sufficient blood for finalising the blood sampling.

CINAS classification=IN1AS2

Explanation

Injection was easy (IN1) but aspiration was not easy but difficult (AS2). Aspiration was not impossible because you end up with what you intended to collect the blood you need for blood analyses through the venous catheter.

Example 2

You start with a blood sampling procedure through an implantable port. When you start flushing you notice that you can inject easily and , also aspirate blood easily. However when you finish to fill the second vacutainer® tube, the blood stops flowing whatever you try (e.g. extra flushing, access the totally implantable port with a longer Huber needle…). Finally, you decide to fill the remaining vacutainer tubes via peripheral vein puncture.

CINAS classification=IN1AS3

Explanation

Injection was easy (IN1) but aspiration was impossible (AS3). Although initially, aspiration of at least 3 ml was possible, the intended complete blood sampling was impossible.

Example 3

You have to administer an IV push medication through an injection port the administration set. Injection is tight, you test the blood return which is impossible.

CINAS classification=IN2AS3

Explanation

Injection was not easy, but difficult (IN2) because you had an abnormal feeling of resistance, blood aspiration is impossible (AS3).

Example 4

You access an implantable port for the delivery of IV chemotherapy and there is no blood sampling required. It is easy to inject, you try to confirm the blood return, which is negative. You take some actions in an attempt to get blood return, at the end you get 2 ml of blood.

CINAS classification=IN1AS3

Explanation

Injection was easy (IN1), it was impossible to aspirate 3ml of blood (AS3)

Example 5

You access an implantable port and there is no blood sampling required. It is easy to inject, you try to aspirate but you have no blood return. You take some actions in an attempt to get blood return, at the end you get 3 ml of blood.

CINAS classification=IN1AS2

Explanation

Injection was easy (IN1), it was difficult to aspirate 3ml of blood (AS2).

Example 6

You just walk in a patient’s room and you see an empty infusion bag. The administration set, which is attached to the patient’s central venous catheter is completely filled with blood. You try to flush but it is impossible , you try to aspirate but you get no blood return.

CINAS classification=IN3AS3

Explanation

Injection was impossible(IN3) and it was impossible to aspirate 3ml of blood (AS3).

Example 7

You just walk in a patient’s room and you see an empty infusion bag. The administration set, which is attached to the patient’s central venous catheter is completely filled with blood. You try to flush but it is impossible, you try to aspirate but you get no blood return. You start thrombolytic treatment and after a few minutes you can inject 1.5 ml of the thrombolytic drug. This injection was possible however it was not easy. You try to aspirate 3 ml of blood which went easily and you get brisk blood return. You tried to inject again, however, this remains difficult.

CINAS classification=IN2AS1

Explanation

Injection was possible, however difficult, definitely not easy (IN2). It was also possible to aspirate 3ml of blood which was again difficult (AS1).

Example 8

You just walk in a patient’s room and you see an empty infusion bag. The in administration set, which is attached to the patient’s central venous catheter is completely filled with blood. You try to flush but it is impossible , you try to aspirate but you get no blood return. You start thrombolytic treatment and after a few minutes you can inject 1.5 ml of the thrombolytic drug. This injection was possible however it was not easy. You try to aspirate 3 ml of blood and this was possible however, you could only aspirate the blood with a lot of efforts with a syringe.

CINAS classification=IN2AS2

Explanation

Injection was possible, however difficult, definitely not easy (IN2). It was also possible to aspirate 3ml of blood which was again difficult (AS2).

Example 9

You access an implantable port and it is easy to inject, you try to aspirate but you have no blood return. You take some actions in an attempt to get blood return, at the end you get 3 ml of blood.

CINAS classification=IN1AS2

Explanation

Injection was easy (IN1), it was difficult to aspirate 3ml of blood (AS2).

Example 10

You have to draw blood via a tunnelled catheter and fill 4 Vacutainer® tubes. The flushing wit 0.9% Sodium Chloride is easy. You start filling the blood tubes but after 2 tubes, blood aspiration stops. You tried to aspirate the blood with a syringe and you managed to fill the 2 other tubes.

CINAS classification=IN1AS2

Explanation

Injection was easy (IN1), it was not possible to complete the blood sampling smoothly because you have to take some actions (using a syringe) to be able to fill the last 2 vacutainer® tubes which made the blood sampling difficult (AS2).

Example 11

You noticed a slow infusion rate and certainly below the prescribed infusion flow rate. You try to obtain a higher flow rate. However, you observed consistently a low flow. Blood aspiration ability was not evaluated.

CINAS classification=IN2ASX

Explanation

The slow infusion rate could not be restored to a normal infusion rate. Infusion can be defined as not easy but difficult (IN2), blood aspiration was not tested and thus unknown (ASx).

Last edit: 23 January 2020