Quote from greyL
What's the proper way to draw blood from a picc line? The other day I flushed with 10 cc's of NS, then wasted 10, then drew blood. But the lab called to say that the results looked wrong (extremely low hemoglobin level) and that the blood probably had saline in it. Another nurse told me that I'm supposed to waste more than I flush and that I did it wrong. Is that correct?
Are you sure that you used the syringe with pure blood instead of accidentally grabbing the waste and filling the tubes? It is not uncommon to accidentally grab the waste on the table, especially when both the waste and draw are 10mL. Having seen this done multiple times, and nearly done it myself, I am willing to bet this is how you obtained such a large amount of saline within the sample to significantly contaminate the test.
Consult your facility's P&P on drawing blood, if there is not a specific method described then the blood bank may give recommendations or your vascular access team. Minimally, twice the internal volume of the catheter should be flushed and wasted. For most PICCs this is somewhere around 1-2mL depending upon the size and length of the catheter.
Proper flushing and proper drawing technique is important. The "Pump&Pause" method is considered to be the gold standard. Instead of flushing or drawing in one single movement of the hand you flush or draw in 1-2mL increments, pause, and continue. The turbulence created within the lumen of the PICC helps to ensure a more homogenous movement of fluid.
If your needless access devices (the end cap/Luer lock) is not clear, so as to be visually inspected for residue, you should be changing those with each blood draw.
Asystole RN, CRNI, VA-BC