[BuffaloLPN]

this might sound dumb, but maybe you're not alllowed to draw because it would affect test results? I am thinking that in some cases, no matter how much waste is drawn, certain things (lipids for ex) would alter labs anyway. It seems like we poke kids for peak and troughs all the time, and they all have piccs or mediports.

[JenMarie]

We take bloods from PICCs using similar protocols as discussed as above. However we are told it depends what size the PICC is. Only able to use it for blood draws if it is greater thatn a size 3 french. If it is smaller than that we always have to have fluids running...which is a real pain for the patient being attached to fluids the whole of their hosp stay.

[jadednurse]

Originally posted by Tory
... Some RN's abide by this and have lab stick the patient for labs. Other RN's draw blood from the PICC reason being,....they don't have any veins to begin with (which is why they have the PICC). I would like to get your opinion on this. I am a fairly new grad and have made waves with this. I used to draw blood from them until I learned the drs said not to. So now I refuse to do it and have lab do it (often times they are unable to get enough blood or can't find a good vein). Just curious. Thanks!

Is it like this with other procedures on your unit...I mean doesn't anyone follow a protocol, or do they all just "do their own thing?" If the protocol for any procedure isn't clear, is their a unit or nursing educator at your instituion whose job it is to review this sort of thing? Have you discussed it with your manager?

[Jay-Jay]

Originally posted by Sleepyeyes
We are not allowed to draw from a PICC when the pt has a heparin gtt, for obvious reasons.

Why not? The reason isn't obvious to me! I would think you would not want to do a peripheral draw on a pt. receiving heparin, because they are much more likely to bleed from the puncture site and get a hematoma!

Of course, you would have to disconnect the drip to do the draw, flush pre and post, then reconnect. That would keep the heparin from contaminating the sample(s) drawn.

In the community we use heparin for 2 things 1) Hepalean is used to flush central lines (usually 10 cc NS, then 3 cc Hepalean) and 2) Fragmin (low molecular wt. heparin) is given to pts. with DVT's by s.c. injection. We don't do heparin drips, so maybe there's something I don't know here....

[amk1964]

i've inserted a few picc lines and do use them to draw blood with 10 cc syringe; BUT the problem i've noticed is other nurses aren't heparinizing the lines after draws. this is important with small lumen caths. i've noticed younger nurses seem to think heparin flush solutions are dangerous. they are misimformed by misimformed teachers. SASH used to be the norm and was and is effective, but hospitals have switched to ns flushes only for the primary purpose of cost-savings. sure are alot of clooted lines these days?????

[caroladybelle]

Jay Jay,

Some facilities prohibit coag draws from heparin lines - as the heparin coats the line and alters the results. Just as the same facilities bar drawing tac levels from tacrolimus lines or chems from TPN lines.

[NRSKarenRN]

Contact Mfr of PICC for latest research, discuss with Cl mgr /administration and if policy can be updated to reflect current research FIGHT FOR PATIENTS BEST INTEREST.

[caroladybelle]

As far as the Heparin problem - I am speaking from experience only.

I have had different nurses draw repeated PTTs from central accesses (that had heparin infusing via the line ) - stop infusion for 15 minutes - flush with 20-30 cc NS - waste 10 cc or more blood and submit specimens to result greater 150 - only to have a draw with a peripheral stick at same time and get a result WNL. Same problem with Tac.

The option, most facilities that I work with go for is double lumens (or triple with some accesses) - reserving one line "clean" with no Tac or heparin used in it.

Interesting thing Karen," X"Philly wants ALL labs drawn peripherally - and centrals reserved strictly for fluids - and that is THE OFFICIAL POLICY.

[NRSKarenRN]

Having had my MIL develop coagulopathy 9 yrs post chemo and seeing her black and blue from fingertips to upper forearms, I'm more sensative to the rights of clients. Portacath relieved her suffering and everyhting was drawn from that.

What is patients DX, what do arms look like these are all things to take into consideration along with POLICY. Use your assessment skill to get variation on policy IF patient is suffering.
I've gotten VO from docs to override policy due to individual patient need.

Yes you do need to follow your facilities P+ P but does'n't mean that new research with improved PICC product might not be waranteed for policy review.

In most adult homecare IV companies I've covered (8 different ones) we drew all labs from PICC---only if erratic labs or smaller than 3 FR did we do peripheral stick---(with execption of Blood cultures).

All policies should be reviewed anyway at least q 1-2 yrs with literature search for best pratice done.

[jblemire]

Originally Posted by JNJ

Any chance there is confusion over PIC (peripherally inserted line) and PICC (peripherally inserted central line). Otherwise mjlrn makes sound statements. However, if the docs. and protocol are not sensible, it's up to the RNs to work up a presentation for change.

I recently accessed CDC guidelines for PICCs and they were surprisingly unspecific (related mainly to infection control issues.) So back to the manufacturer of the line most commonly put in in your unit. Can the rep. help you here? The flushes/waste blood amount mentioned in above posts sound huge to me. The volume in these lines (in pediatrics) is really small, around 0.3 ml per manufacturer.

Absolutely agree with nothing less than a 10cc syringe. Both pushing in and pulling out, smaller syringes create more pressure. I've demo'd this to students with a removed line.

I now work with an 18 month old PICC line with two ports which is maintained on a 30 lb child with obsessive attention to technique. We draw blood x 2 weekly, small pre and post flush of saline. Patency is maintained with q24h with 3 cc heparin. Valve change q3 days. 10 cc syringes. I cannot imagine managing her care without a PICC.


Incidentally, anyone out there with a line older than 18 months? What's the record on this?

If you are accessing the picc line several times during the day for antibiotics, how often do you flush with hepelean??