Do you draw blood from a PICC line?

  1. OK ongoing discussion at my LTC . Do you draw blood from a PICC line? Here in LTC we are not allowed . One of the nurses did it and got in hot water . Is it a hospital only thing ? Or is it allowed at other facilities?
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  2. 13 Comments

  3. by   VivaLasViejas
    Well, since I work in a hospital, I draw blood from whatever source I can......PICC, central line, even a peripheral if I can get it. I'm unaware of any different rules for this in LTC, except you have to be an RN to perform this, but that's the case in the hospital as well. Sorry I can't be more helpful.
  4. by   nesher
    Of course you can draw blood from a PICC - it is inhumane to think you are poking the person when they have a perfectly good central line to draw from! You need to get this mentality changed quickly!
    Why would the nurse get in "hot water" for using the device in the manner in which it was created?
  5. by   SharonH, RN
    Quote from xmaxiex
    OK ongoing discussion at my LTC . Do you draw blood from a PICC line? Here in LTC we are not allowed . One of the nurses did it and got in hot water . Is it a hospital only thing ? Or is it allowed at other facilities?

    How silly. What is the justification for such a practice? Drawing blood without sticking the patient is one of the advantages of having a PICC.
  6. by   CHPN1680
    There are many issues here that may be getting confused. First let me say that I agree that a patient should not have to suffer a venipuncture if they have a perfectly good line already in place.

    There are so many regulations in the long Term Care industry that I think it make people afraid to do anything. Often the issue has to do with scope of practice and most LTCF's use LPN's. Depending on the state, LPN's may not be allowed to access a PICC line.

    Also, in many facilities, the staff doesn't do the blood draws. They contract with and outside lab who sends a phlebotomist (sp?). They are not allowed to access a PICC as far as I know.

    The Director of Nurses and/or the staff educator should research the scope of practice and the facility policy on this. Then everone should be educated so that they know how to proceed.
  7. by   PamRNC
    I don't know about LTC. That said, I do know about policy. What is the policy in your facility? If you follow policy, you're ok. If you don't follow policy, the facility will hang you out to dry.

    Your facility accepts patients with PICC lines, so somebody must be able to access, flush, deaccess and change the dressings. Perhaps that somebody is also the person who can/should draw the blood? If the policy specifically states no blood draws from a PICC, two things need to be checked out: 1) why - was there an incident; 2) can the policy be changed.

    Policies are the words on paper outline the risk an institution is willing to accept. I've worked in different hospitals each had different rules about who could do what with PICCs. One facility would not risk losing the PICC and said no blood draws, and only the IV team was allowed to flush/change dressings/access/deaccess the line. All PICCs had to be on continuous drips once started, unless the pt was in severe CHF and needed to be fluid restricted. That meant the IV team had to flush the line q12hr, something they had a problem doing because of their staffing - maybe 1 IV nurse overnight.
  8. by   SharonH, RN
    Quote from BobL
    There are many issues here that may be getting confused. First let me say that I agree that a patient should not have to suffer a venipuncture if they have a perfectly good line already in place.

    There are so many regulations in the long Term Care industry that I think it make people afraid to do anything. Often the issue has to do with scope of practice and most LTCF's use LPN's. Depending on the state, LPN's may not be allowed to access a PICC line.

    Also, in many facilities, the staff doesn't do the blood draws. They contract with and outside lab who sends a phlebotomist (sp?). They are not allowed to access a PICC as far as I know.

    The Director of Nurses and/or the staff educator should research the scope of practice and the facility policy on this. Then everone should be educated so that they know how to proceed.

    Excellent points Bob. I hadn't thought of that.
  9. by   TracyB,RN
    Depends on the size of the PICC line.... A smaller french can result in collapse of the PICC tubing...
    Don't do it if you don't have at least a 10cc syringe to draw with.... too much pressure in a smaller syringe.
    Also, if the PICC has the PASV valve (for positive or negative pressure.. to draw or flush) certain saline lock flushes can interfere with the function of the valve. If I recall correctly, PICCs with this type of valve only need to be flushed with saline, NOT heparin...
    Hope this helps
  10. by   oldnewnurse
    Staff RN's do not do blood draws at my LTC facility. However, we do have patients that come to us with PICC's or come back to us from the hospital with a PICC. They often have IV antibiotics running. No matter if they have something running or not, our policy is to protect the PICC for as long as possible. Each lumen gets flushed by an RN with 5ml of NSS and 3ml of heparin q shift. After the NSS flush, I attempt to get a blood return prior to the heparin push. Then I document that I flushed each lumen with the NSS and heparin and got (or didn't get) a blood return. When we determine that the PICC has gone bad (won't flush or no blood return) we D/C the PICC. Honestly, I see them going bad (poor/no flushing?) much more quickly than when I worked at the hospital.
  11. by   nursypoo
    We are not allowed to draw blood from PICC lines but I also work at a peds hospital. The catheter size may be too small for that type of manipulation.
  12. by   sockov
    I work in the ICU, and if a patient has a picc, it usually is the result of having poor access!
    I draw blood from picc lines, but you must use a 10cc syringe, not a vaccum type device.
    Then flush it with 10cc saline afterwards.
  13. by   DutchgirlRN
    Quote from xmaxiex
    OK ongoing discussion at my LTC . Do you draw blood from a PICC line? Here in LTC we are not allowed . One of the nurses did it and got in hot water . Is it a hospital only thing ? Or is it allowed at other facilities?
    We are allowed to draw blood from a PICC or a Central Line but only if we have a Dr's order. I'm in a hospital in Tennessee.
  14. by   TiffyRN
    I've drawn from PICC lines many times but in an acute care hospital. I do know the size of the catheter is important however it sounds like a review of policy is needed at your facility. I know oncology MD's that would be mad if a nurse stuck his patients who had a functioning PICC in place. Also I know it may be important if an RN is available at a LTC to do the draw, everywhere I've worked it's been a practice restricted to RN's.

    As far as catheter size, we do draws from neonatal PICCs that have french sizes <2 french. They last as well as other PICC lines I've worked with. But unlike LTC facilities we have MD's and/or NNP's on the unit 24/7 who can replace them if needed.

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