Nurses not flushing out P.I.C.C. lines

  1. :wakeneo:
    Last edit by Trauma_Team_1 on Aug 20, '06
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  2. 40 Comments

  3. by   adria37
    There are many reasons why a picc line becomes unusable for lab draws. Our facility (I am an oncology nurse) does not use picc lines or ports for routine lab draws. They are considered "infusion devices". I find it offensive that you say the piccs don't work due to "lazy nurses" most nurses are not lazy they are hard workers and if they are not they don't last long
  4. by   nhelkhound
    When I was doing my first med-surg rotation I had a patient who had had a PICC placed 10 hrs prior. A phleb came in to do a draw. This patient's arms were severely bruised and extremely tender from numerous sticks over many days. I asked why the PICC wasn't being used. The phleb didn't know. I asked the RN assigned to the patient who also didn't know. I asked my instructor: she/he didn't know. The patient received more sticks to acquire a sample. The poor guy looked like he was gonna cry. How dumb is this situation?!!
  5. by   Marie_LPN, RN
    Quote from Trauma_Team_1
    My question is WHY does it seem like most of the pt's that i encounter on my daily run who have P.I.C.C lines 90% of them are clogged?
    Beause typically people with PICCs have other issues aside from bad veins (such as coag abnormalities).

    What really tee's me off is when i go up there to do a draw ( i really shouldn’t be up there because the RN is the one who draws off the P.I.C.C. not the phlebs, but they never tell us the pt has a line at all until we are in the room and staring at it)
    Shouldn't you look and see if they have a line before you'd get started, instead of blaming the nurse for yet one more thing? (I was trained to see if there was a line first, before i drew)

    When I go get the nurse to ask why was the lab called to do a draw when the pt clearly has a P.I.C.C. most of the time they say " OH its clogged". Not only is this unacceptable ( how hard is it to flush saline or heparin in the line to prevent this?)
    Flushing heparin, saline, or heparin saline doesn't always prevent this though.

    Is this a common thing for nurses to allow the P.I.C.C. to clog up like that?
    "They" are not always allowing the PICCs to clog.

    They need to know that the ones who take the wrath from pt's are the phlebs that must now draw from a hard if not near impossible stick because the nurse was to lazy to clear the line.
    Try to see all sides of the coin before it's just assumed that the nurse is "lazy" and isn't flushing the PICC. Unless you have access to the pt.'s chart, or followed the nurse around for their whole shift, you do not know 100% that the line wasn't flushed.



    As for 'wrath', your post just reeked of it.
    Last edit by Marie_LPN, RN on Aug 19, '06
  6. by   Marie_LPN, RN
    There are many reasons why a picc line becomes unusable for lab draws. Our facility (I am an oncology nurse) does not use picc lines or ports for routine lab draws. They are considered "infusion devices".
    That too.
  7. by   leslie :-D
    in nsg school, i was taught never to assume.
    they didn't teach you that in your phleb course?
    i'm sure some nurses are guilty; not most.
    where i worked, we had to sign off on the iv drugs and all scheduled flushes.
    it was easy to assess when such problems began.

    leslie
  8. by   Empress
    I'm working as a phlebotomist right now as well, and I haven't encountered that. I know little about PICC lines and lines in general, if they tell me it won't work, I go from there. I still have a job to do. *shrugs*
  9. by   neetnik461
    Trauma Team 1 wrote:

    My question is WHY does it seem like most of the pt's that i encounter on my daily run who have P.I.C.C lines 90% of them are clogged?
    One of the reasons I have witnessed for PICC lines clogging is erroneous thinking that a KVO of 10-20 ml/hr will keep the line open without having to flush it (often done on PICC's with unused/multiple ports). Our unit has standing orders for flushing of all PICC ports, BID with 10 cc saline, push/pause method. Actually, from what I understand even ports that have IVF and other drips continually running should be paused and flushed out twice a day because it's the "push/pause" pressure that helps keep the catheter patent (not just a steady stream).

    Also, the PICC can sometimes become lodged against the side of the superior vena cava in such a way that it is no longer patent. I have seen clogged/unusable PICC's miraculously become patent again when a patient is turned and the cathether (obviously) moves away from the wall of the vessel.

    Believe me, nurses would much rather draw a sample off a PICC line themselves then wait 1-2 hours for phlebotomy to show up (at least at my facility). PICC's are simple to draw from and make a nurse's life a lot easier in other ways too (no infiltration to worry about etc), a nurse who would puposely let a PICC clog (out of sheer laziness) is one who is shooting herself in the foot by making more work for herself. So, please don't assume that lazy nurses just let PICC's clog up because phlebotomy will be in to draw the samples anyway :trout:

    Why not try to be part of a solution?? The number of clogged PICC's you are seeing is not helping the nurses job or patient care. Maybe talk to the CNS on the floor or to your phleb supervisor about what you are seeing and your concerns (about the number of clogged PICC's, not the assumed laziness of the staff).

    nhelkhound wrote:

    I asked why the PICC wasn't being used.
    One of the reasons the PICC may not have been used is if a heparin drip was running through it and the test being drawn was a Coag screen (these are typically done q6h when a pt. is on a heparin drip). In that case a peripheral stick would be required, because to draw a sample from the same line that the heparin was running into would result in a PTT so high that it could be entered into the Guinness Book of World Records!!
    Last edit by neetnik461 on Aug 19, '06
  10. by   Trauma_Team_1
    Its no secret that the lab and the Rn's dont get along very well ( Im not sure why this is, but there seems to be a mini battle going on all the time between the two)... I assure you that we are just as busy as you ( maybe even MORE so). We have our tricks also, such as if there is a floor that is treating the lab staff particularly bad we just take more time to get up on the floor ( the doc's call to ask what the hold up is, and we just say for them to speak to the nurse/nurses on that floor who think they run the show.... and AMAZINGLY we get a nurse that calls to say "oh im so sorry") Btw the MT's will play this game also if they get a nasty call from the floor.

    Im in nursing school right now so im getting a good appreciation on just how little some nurses think of the lab staff. Sadly
    Last edit by Trauma_Team_1 on Aug 19, '06
  11. by   SharonH, RN
    Quote from Trauma_Team_1
    Its no secret that the lab and the Rn's dont get along very well
    That's interesting, I've been a nurse for over 15 years and I've never heard of this antagonism between nursing and the lab. I'm surprised you want to be a nurse since there is contempt on your part.
  12. by   Trauma_Team_1
    Quote from SharonH, RN
    That's interesting, I've been a nurse for over 15 years and I've never heard of this antagonism between nursing and the lab. I'm surprised you want to be a nurse since there is contempt on your part.

    Not on my part...ask the lab staff......
  13. by   leslie :-D
    i have to agree with sharon.
    it sounds like the antagonism is at your facility, i assure you.
    please, get into the habit now, of treating everyone as an individual.
    it will save you much unneeded conflict.

    leslie
  14. by   Roy Fokker
    Ok, I'm not joking.

    I've seen PICCs "clog" because the pt. refused to keep the extremity 'somewhat' straight.

    Again - I'm not joking. This sounds patently absurd, neigh impossible... but there you have it!

    There's only so many times you can remind someone "Hey! keep that arm straight, will ya?" or would you rather arm-board a 40 year old who wasn't very co-operative to start with?
    Last edit by Roy Fokker on Aug 20, '06

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