Pt w/ a PICC line on a heparin gtt

Nurses General Nursing

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I am not a new nurse, and yet I still do not know the definitive answer to this question :bugeyes: since I've heard so many nurses argue both sides. The question: Is it ok to draw a ptt from a PICC for the pt on a heparin gtt? That is, if you flush w/ 10cc and discard 10cc, have the heparin off for like 10 minutes or so, and draw from the lumen that did not have the heparin infusing?

Like I said, many nurses have no problem doing that and then there are others who are adamant that a ptt must be obtained via peripheral stick. So what do you do and why? Thanx.

I will tell you all that I did see a similar thread on this topic posted about a year ago and someone made a comment something to the effect that the body's response to venipuncture affected clotting factor levels. Very insightful. Any thoughts to add to this?

Specializes in private duty/home health, med/surg.

We don't draw coags off of the lumen that has the heparin infusing in it. Our hospital policy allows nurses to choose if the capped lumen should be flushed with heparinized saline or just with 10ml NS Q 12. If they are on a heparin gtt, we mark a lumen that shouldn't get heparinized saline flushes. If they've already been getting hep flushes then we have to draw peripherally.

Specializes in Jack of all trades, and still learning.

I've taken blood from piccs, but never for APTTs. I'd be interested to see what our lab thinks about it! Thanks for raising the question.

BTW our hospital policy is to discard the blood withdrawn.

PICCs are generally placed in patients who have long term antibiotics, or have an inability to access peripheral veins, in our facility. We use CVCs if patients are from ICU. I have never seen heparin administered as an infusion via a PICC. That does not mean of course that it doesn't happen....

Once again, thanks for raising the topic

That is probably true. I am on an ICU..so the vast majority of our patients need one...long term mulitple antibiotics..drips, and lots of fluids. We do not give them to everyone...like my pp made it sound. Our stable patients that will transfer within days, our OD's etc..they just keep their PIV's

Okay, good! I was scared for a minute!!! ICU = acceptable, haha! Thanks for the clarification.

Specializes in Trauma/ED.

We have a hospital policy to never draw blood from a PICC. Always thought that was interesting because I have done it so frequently in other hospitals. So if I have a patient insisting on not getting another stick I just have the MD write specific order "ok for blood draw from PICC".

I guess the story is a couple PICC's were occluded after blood draws so they made a blanket policy--instead of educating the nurses who made those draws--typical management movement.

I drew a PTT from a PICC line which had not been flushed w/Heparin in over 36 hours. (We had a KVO infusion to prevent capping & recapping...also enabling piggyback antibiotic infusions w/o disruption to the patient). Heparin was infusing through a peripheral line on the same side. After initially obtaining the PTT from the PICC line, a senior nurse questioned my practive. After consulting with the lab for the next draw, I stopped the Heparin drip for 3 minutes, flushed the PICC w/10cc NS, wasted 2-12cc tubes of blood, then obtained my sample. At the beginning of my next shift,the same senior nurse questioned if I had indeed drawn the PTT from the PICC line again. After explaining my procedure, she proceeded to tell me absolutely NO PTT DRAWS WERE TO BE DRAWN FROM A PICC LINE EVER, simply because at one time there had been Heparin in the line. Please someone give me some insight because I assumed this was a no brainer. Is this a power trip or did I make a bad nursing judement call??

I know this is an old thread, but we don't draw any coags from a central line. Period. On heparin gtt or not. Our central lines are maintained with heparin.

Specializes in cadiac-thoracic post sx.

this is an interesting question. one i have had at work. it seems to me so many things are based on nursing judgement (which can be scary depending on the nurse) but what i was taught (not that i have seen a policy, but will look at work next time) is too stop heparin gtt for about 10mins. flush with 20cc, waste 10cc, and pull sample of blood.

and by the way the though of putting the blood back is scary. those 10cc syringes are not sterile. where do you keep the blood filled syringe when your pulling the other blood, theres no way to keep that sterile. that just scares me to no end. but i have seen nurses in the icu do that too. don't know what the policy is on that either but would be interested if other nurses do it too.

Specializes in Management, Emergency, Psych, Med Surg.

I personally do not draw a PTT from the same line where the heparin is infusing just like I would not draw a K from where the K was infusing. That is just what I have learned and is my personal preference, no matter what the policy says. It is just too easy to get an incorrect result.

Specializes in NICU, Post-partum.

You shouldn't draw off the PICC unless you have no other access...and yes, that means you have at minimum, attempted access.

The reason being, is if you blow that PICC line, your patient may have to have another line inserted that may require a surgical intervention.

So you avoid it at all costs.

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