[veronica butterfly]

At your facilities, do you always need a doctor's order to be able to draw blood from picc lines or portacaths? We do at mine, and often when someone is admitted to the hospital, that order is overlooked. This poor pt who has a picc or a port then ends up being needlessly poked/drawn until someone figures out and/or takes the time to call the doc and get an order.

Is there a reason why you wouldn't be able to automatically collect blood from a picc or port?

thanks!

[gitterbug]

If ER admit then ER attending can write order for blood draw from PICC or Portacath. Otherwise, calling a physician for order is correct protocol. Patients with PICC or Portacaths here refuse to be stuck for blood simply because they have these devices implanted for blood draws, why do your patients allow themselves to be stuck and usually without success?

[veronica butterfly]

Originally Posted by gitterbug

If ER admit then ER attending can write order for blood draw from PICC or Portacath. Otherwise, calling a physician for order is correct protocol. Patients with PICC or Portacaths here refuse to be stuck for blood simply because they have these devices implanted for blood draws, why do your patients allow themselves to be stuck and usually without success?

I agree, it is sooooo frustrating to me to get a patient for the first time after they've been in our facility for several days and see they have a picc/port and lab is still coming.... I'm new to this profession and don't want to come off as a 'know it all' to my experienced coworkers, but this just burns my britches. And I work mostly nights so at midnight, I get to decide whether to call the doc and request that I can draw blood in a few hours.... Where is the compassion, and isn't that why we hopefully got into this difficult and rewarding job? I don't understand why we need the order since, yes!, isn't this the point of a port?

Why do these folks allow us to continue to needlesslypoke them? Because they are sick, vulnerable, and trusting. Oh, don't get me going....

That's an excellent point about ER getting the order, next time someone comes from ER, I will ask that at report, and also bring this up at our next staff meeting.

[crb613]

We don't need an order but an RN is the only one that can draw the blood.

[RNsRWe]

We need an order to access an infusaport for the first time. No orders needed to draw from a PICC or port (once opened).

[Daytonite]

Originally Posted by veronica butterfly

Is there a reason why you wouldn't be able to automatically collect blood from a picc or port?

Actually, no, there isn't. But, I believe that the major reason that many facilities do prohibit blood collection from PICCs or ports without an order or a facility policy is because PICCs, in particular, if not flushed properly after blood draws will get clotted up. Most facilities do not have many nurses on staff that are able to de-clott these central accesses unless they have IV teams or nurses in the intensive care units who are trained in de-clotting. It is far more inconvenient to have a line clotted up than to have the lab come up and stick the patient.

Because I worked on an IV team for years and was certified to insert PICCs and repair Hickman as well as triple lumen catheters, I would draw blood from all these lines. Of course, I knew my facility's policy. The trick is to pull the blood gently through the PICC since the lumen is small and then flush it liberally with 20 to 50cc of saline in order to clear all the blood from the lumen. Remember, a PICC line is often 30cm long from the insertion point in the arm to it's distal point in the vena cava. There's a lot of blood cells that can linger in that catheter and they need to be fully flushed out of the lumen of the PICC.

[CarVsTree]

We don't need an order for either. So, I draw from PICC's all the time. We did have a GN draw blood and forget to flush afterwords. PICC team had to come the next day and flush with TPA.

Regarding ports, you need to know how to access a port in order to draw. I work trauma and very rarely see ports, so when it comes up we call a nurse on onco to either show us or draw it or us.

[veronica butterfly]

Originally Posted by Daytonite

The trick is to pull the blood gently through the PICC since the lumen is small and then flush it liberally with 20 to 50cc of saline in order to clear all the blood from the lumen. Remember, a PICC line is often 30cm long from the insertion point in the arm to it's distal point in the vena cava. There's a lot of blood cells that can linger in that catheter and they need to be fully flushed out of the lumen of the PICC.

That's really interesting. Our protocol when drawing from picc/port is to finish by flushing with 10 cc saline. 10.... You're completely right that 10 cc is not enough to go the whole distance of a picc. Thanks, I'm bringing this up at work.

[wmsclan]

We don't need an order to draw from a PICC. Need a one time order to access a port and only RN's can do that. Once the port is accessed both RN's and LVN's can draw blood/push meds etc.

[1studentnurse]

In my state, only licensed nursing personnel can draw from PICC lines or Portacaths.

In my facility, any new PICCs or Portacaths must be assessed and accessed initially by our IV therapy staff before we can do anything to them at all, period. This means if new guy needs his Vanc at 1800 and he arrives at 1759 it's late until IV therapy gives their blessing on his line (assessment, flush and dressing change). Floor nurses cannot initially access a Portacath, either. Only the IV therapy folks can at our place.

After IV therapy does their work, the floor nurses maintain the lines. We follow protocol to flush with saline before and after draws. If the patient needs heparin for them, we have to get an order to flush with heparin.

If it clots, it's a pain, because we need an order for Alteplase, once, of course, the IV people determine that it's really clotted. You'd be surprised how people think a line is clotted when it's not really. When in doubt, I always move the patient around as needed and use more saline, if possible.