Use of central line/picc line for routine lab draws - page 2

by Amanda Schmidt, RN

7,958 Views | 17 Comments

:confused: Is it ok to use central/PICC lines to draw routine labs from just to save the patient a stick?... Read More


  1. 0
    I regularly draw AM labs from PICCs, IJs, subclavians, and Portacaths. Easy for me, easy for the patient (if I'm quiet enough, sometimes they don't even wake up!). I just make sure to flush well before and after, and never draw through the cap. Sometimes we get patients with really narrow gauge PICCs, and those are difficult to draw from (hemolysed a sample once..oops!) but for the most part, IJs and subclavians are easy peasy. Just need the order that it's okay to use I work ICU stepdown/telemetry.
  2. 0
    The idea of having a PICC or Portacath in the first place
    is because the pt. has NO veins.
    Abide by your facilities policies, but yes, USE them!

    Withdraw the appropriate blood before taking the sample, and flush well!
  3. 0
    Quote from OrionQuiltsRN
    I spent six months receiving chemotherapy for lymphoma this year. Lymphoma is gone! I am well and anxious to find another RN job. I had a power PICC in my right arm. It was probably the best thing about this past year. I had blood draws every day through my PICC, sometimes twice a day. All my IV fluids, chemo, and blood transfusions went through that double lumen. Once the PICC line was established I never had another stick. I loved my PICC line.
    Happy to hear of your good health!
  4. 0
    YES it is a perfectly acceptable practice to draw blood from from Central lines and PICCs and ports. Erroneous lab values are usually from a incorrect technique. There are many ways to perform this improperly such as using the discard instead of the draw...NOT shutting OFF all infusion in all lumens for one full minute (YES one full min is enough)..forgetting to shut off any infusions distal to the line,not discarding enough of a waste,pulling the blood from the line with too much force or pressure or using a vacutainer system for a PICC line draw ( syringe is preferred for a PICC line then transfer to lab tubes). Any flush of PICC OR CVC should be at least 2 x the priming volume of that line..most are. IT is very important that you flush immediately and properly after the draw...check your policies....good ones will double the normal saline after a blood draw...a push pause flush was very popular in the laast 10 yrs.....now IV experts say a nice smooth flush is the best. The way to flush and with what is still being researched so recommendations from INS and the experts may change with new research findings.
  5. 0
    What is the rationale for not using the vacutainer with PICC draws? Is it due to increased risk of hemolysis? We use vacutainers on PICCS at our facility.
  6. 0
    i work critical care and we use PICCs specifically for those who have a long hospital course ahead of them with lots of IVFs, electrolyte replacement, gtts, etc and/or those who have ahem.. s*** for veins. (we've all had patients like those.) we just shut the fluids off for a min or two, flush well, draw and go. for heparin if possible we use a straight stick but i have had MDs tell me on someone who had absolutely no veins of any fashion to go ahead and use the picc just flush flush flush or use the port that didnt have heparin infusing thru it. sometimes for ESRDs who have implanted ports we get permission from renal to use the ports they use for dialysis cause we all know NOONE ESRD has any kind of vein left...


    i recommend PICCs often, when i see what the long-term plan is for my newly admitted pt from ER. for instance, last week i admitted a very healthy 60 year old with a just-diagnosed brain mass. she is facing craniotomy tomorrow..when i saw the surgeon at 0530 come around to talk with her i definitely brought up a PICC and she immediately agreed that it was advocacy for our patient, that she was facing potentially tons of lab draws, infusion of harsh drugs, gtts...

    i also took care of a guy right before discharge who was 3 weeks post crani for cerebellar mass removal. i went in to access and his arms from the armpits down were dark blue/black/purple with hard spots all over!! i said, OMG didnt you have a central line of some kind?? i looked thru his chart later, he had all kinds of potassium/phenergan/vanc and other damaging drugs instilled and noone ever thought to ask about a picc line, he spent 3 weeks in hospital and his internist thinks he has permanent damage to both his arms.
  7. 0
    I agree with everyone else too for the most part. I draw off of all central lines daily, and like others have said, the greater majority have the central lines because their veins are craptastic The main issue comes when they eventually develop that fibrin tail and have to get activase ordered early in the AM.

    I just love how much the patients appreciate their central lines...almost all are extremely grateful to not have that extra needle stick in the AM.
  8. 0
    Quote from iluvivt
    YES it is a perfectly acceptable practice to draw blood from from Central lines and PICCs and ports. Erroneous lab values are usually from a incorrect technique. There are many ways to perform this improperly such as using the discard instead of the draw...NOT shutting OFF all infusion in all lumens for one full minute (YES one full min is enough)..forgetting to shut off any infusions distal to the line,not discarding enough of a waste,pulling the blood from the line with too much force or pressure or using a vacutainer system for a PICC line draw ( syringe is preferred for a PICC line then transfer to lab tubes). Any flush of PICC OR CVC should be at least 2 x the priming volume of that line..most are. IT is very important that you flush immediately and properly after the draw...check your policies....good ones will double the normal saline after a blood draw...a push pause flush was very popular in the laast 10 yrs.....now IV experts say a nice smooth flush is the best. The way to flush and with what is still being researched so recommendations from INS and the experts may change with new research findings.
    PICCs and CVCs should be flushed with far volume than just more than 2x the priming volume since the priming volume of most PICC lumens is around 1ml. 10-20 ml is more common (and effective).

    Who are the experts that say a nice smooth flush is best? With SOLO or other valved PICCS, a pulse technique is very important to clear blood from the valve. When we first started using the SOLO PICCs we saw our TPA for occlusion usage quadruple. We then realized that the original information posters for the SOLOs did no mention using a pulse technique, once we started using pulse technique, our TPA usage was cut in half (it's still twice that of heparinized lumens, but at least it's not 4x that anymore).

    What to flush with in terms of heparin seems pretty well established in terms of evidence; 10 unit/ml heparin is statistically similar to 100 unit/ml heparin making it the preferred heparin flush to reduce total heparin load to the patient.

    I assume you intentionally divided the INS and "experts" into two separate groups since I don't think I would ever use the term "expert" to describe the INS, nor do they seem that interested in research.


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