Question on Drawing Blood from PICCs

IVRUS, BSN, RN · Jul 22, 2008

Why is it that after a patient has had a PICC for 2 or so days (if even that long) you are not able to draw blood from the line? So many PICCs I've seen don't show an ounce of blood return.
What does it mean if you are unable to aspirate blood?
Also, why is it that some ports don't give blood return and others do?

Abundantjoy07,

(BTW, Great name)

After the placement of ALL IV catheters, fibrin (which is a mixture of immunoglobulins, formed blood elements, etc) builds up on the external &/or internal surface of the IV catheter. In many cases, this fibrin acts as a one way valve at catheter's tip: when you flush, the fibrin pushes out and allows infusion, however, with negative aspiration it covers the lumen opening or valve and occludes the line and prevents you from getting a free-flowing blood return (called Persistant Withdraw Occlusion-PWO). This fibrin is also a precurser to thrombus and bacterial colonization.

In other instances, it may be as simple as employing nursing interventions to get your blood return. One that works infamously for me is to have the patient turn his or her head and cough. Usually I'm able to obtain a free flow using this measure. Other nrsg interventions include changing the pt's position, if they are on their side, lie them onto their back or raise their arm.

If you have a PWO, perhaps you could obtain an order for Cathflo to instill in these catheters.

Importance needs to be placed on flushing using the right method, right time and right solution approach. Also remember, a 3 fr. PICC may not yield a great blood return due to its small diameter and when drawing from a 4fr or > PICC, slow steady withdraw is appropriate so as not to collapse the IV catheter with a vigorous withdraw. Also remember that with withdraw, a 10 cc syringe will collapse the catheter quicker, or more easily than a 5 cc syringe will.

Hope it helps..DD:twocents:

Daytonite, BSN, RN · Jul 23, 2008

attention needs to be paid to the size of the syringe you are using to aspirate and how much force you are using in pulling back on the plunger. small syringes create higher pressures in the catheter than larger syringes do. with some of the soft catheters and using small syringes, you will collapse the catheter and nothing will be aspirated.

if people don't flush with enough saline to clear debris out of these lines, they will get clogged up. we flushed our piccs with 20ccs of saline and more after withdrawing blood from these lines and more frequently if there were issues with them getting sluggish to keep them patent.

if the picc line has been placed in the left arm the chance of the catheter being kinked off due to the patient's arm position is higher than if the catheter has been inserted in the right arm. this is because of the anatomy of the veins.

ports are a pain in the rear end. i can't tell you why one day they won't work and the next they do. had a lot of complications with them. we had a number of them completely turn around in their subcutaneous pockets and had to be removed. most of the oncologists where i was were discouraging patients who asked for them from getting them and going to hickman lines instead.

IVRUS, BSN, RN · Jul 28, 2008

"Small syringes create higher pressures in the catheter than larger syringes do. With some of the soft catheters and using small syringes, you will collapse the catheter and nothing will be aspirated."

Daytonite,

Smaller syringes DO yield greater PSI's when infusing, however, the smaller syringes do NOT produce as great of pressure with aspiration that larger syringes do.

DD

abundantjoy07, RN · Jul 31, 2008

Thanks for the great replies, this clears up a lot of issues I've had using PICC lines. I've also learned quite a bit from reading these posts. I have never tried asking a patient to turn their head to cough, that one is new to me, but I definately plan on trying it as soon as I can.

Thanks again! :up: