Ok, I have this pt that had PICC placement done. CXR states the cath tip is in the left innominate vein. (Due to pt's hx of cancer w/mets the tip will not advance to SVC on both arms.) Anywho, doc said this PICC was ok to use. I did not feel comfortable drawing blood considering this IV is not truly a central line, so I got the lab draw instead. Am I wrong?
Jun 2, '09
If the tip of the PICC does not reside in the SVC, it is considered a Midline. You can use it but watch what goes through it. Check the meds the pt. is on and make sure they are okey through a midline. Meds with a ph of less than 5 or greater than 9 can not go through a midline, also if the osmolality is greater than 600, the med can not be given via midline. You can draw blood from the line, as long as it gives blood. Sometimes it may not give blood return, which isn't an issue for use.
Hope that helps.
Jun 3, '09
I answered this ? in general nursing and NO it is NOT considered a midline. A midline terminates in the upper third of the upper arm below the axillary vein. What this is ...is a central line that has a sub-optimal tip placement. Optial is at the cavoatrial junction for any CVC including PICCs. OK here is reality and what you need to do to cover yourself. There are many times that a CVC WILL not advance to that anatomical location for pathophysiological reasons AND the patient has no other options. This happens more than you would think. So you look at the whole picture and weigh the risk vs the benefit to the patient. The risk of using a line outside of the SVC is a greater risk for all CVC-related complications ,especially thrombosis. The benefit is that the patient can get their prescribed therapy and their blood draws. The only thing the MD may not want to give in this vein is TPN and perhaps continuous vesicant chemotherapy...but even then I have seen cases where we had no other options even when interventional radiology could not get something better. If you can get something better..try for it. So if we place a PICC and can not get it past th innominate vein..we try the other side..and then if we can not get that we send them to radiology. If you can not get a better placement get order to use i....instruct patient well,,and monitor for complications...document all attempts to place the CVCs and why a CVC outside of the SVC is being used.
Jun 5, '09
Although quite convenient, drawing blood from a PICC is not worth the possible damage it can cause to the PICC. Most MD's here in New York do not write orders for such a lab draw.
Jun 5, '09
Looks like no one has actually succinctly answered your original question,so without further ado....
If your pt's line flushed easily and gave you a good blood return (roughly and unscientifically defined as >5ml in < minute) it should be fine to use to obtain blood samples,so you could have saved him/her a stick.
Jul 1, '09
this is rather late, however, my facility does not approve use of "midclavicular" catheters, d/t catheter whip, etc. and I am pretty sure INS states a picc line must be placed in the distal 1/3 of the svc. as stated above by another comment we will try the other arm or opt for IR placement. tpn should never be infused through a line other than central, at least at my facility and most others. (i know i should never say never..but there it is)
Jul 6, '09
Drawing blood from a PICC does not damage the PICC....what it can do is increase the risk for occlusion..usually do to improper flushing.....use a pulsatile.....push/pause...or start/stop technique....a few names for it...but as long as you do it properly that is what is important....and have the flushes ready....not come back with them 5 min later....yep...see it happen more than I want to admit
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