Drawing blood from PICC lines - page 2
I work on an Oncology unit where many pts have PICC lines. there are 3 drs that routinely start them for us. These drs say that we are not to use them to draw blood for labs. They have said that... Read More
Feb 3, '03Voumes for peds are smaller, of course. Usually with an adult blood draw, we waste a whole vial of blood (red topped tube, which I think is about 7 mls.) Flushing is done pre and post with 10 cc NS, and 3 of hepalean (usually). We used to always have to clamp it off as we were flushing (positive pressure flush) but some of the newer valves don't require this technique. And never anything smaller than a 10 cc syringe, where a central line is concerned. Same goes for a midline, too.
Feb 3, '03With neonates we only draw from a PICC for a PICC blood culture. We waste 0.5cc and then draw 1cc for the culture. Half the time you can't get it to draw back. We flush with 0.5-1cc of NS if we are going to hook IVF up or heparin if we are heplocking it. We usually use a 3cc syringe but we are not specifically barred from using a 1cc.
Feb 3, '03RN's insert the PICC's where I work. And we definitely draw off of them. Why else would they have it? That doesn't seem to make sense... I guess it does have to have something to do with the size of the catheter as has been mentioned above. You need a protocol that is written and clear as to what can be done. It doesn't seem fair though to insert a PICC and then still stick the patient for labs. If the docs don't want PICCs being drawn off of, they ought to insert another type of access that can be used long term and can be drawn off! These patients are already going through enough!!!!
Feb 4, '03They don't want us to draw from the PICC either...say that the risk of clotting it is too great.
We are moving away from the PICC and central lines though and going to the Portacath system. They have told us there's no prob with drawing blood from them and they last longer.
Feb 13, '03We do not draw labs from PICC or Portacaths. The MD's said it increases the chance of infection in the central lines too much and they want them saived for antibiotics and chemo .
Feb 13, '03We don't usually draw from PICC's either. I think our docs wait too long to make the decision to put a PICC in and then it's too late because event the antecubitals are shot. We have a lot of old people who generally don't have veins to start with.... We have been using midlines a lot more for peripheral access and having good success with them. The lumens on the PICC's just seem like they are too small to draw blood through without clotting it or damaging the line. But, hey what do I know? Our facility is usually about 10 years behind the times anyway....
Feb 13, '03We always draw blood off the PICC line. That is one of the advantages for your patient. Check your actual policy and educate your doctors with proof of policy. Just because they say no, doesn't mean that are right!!! Be the advocate for your patient!!!
Feb 13, '03Gosh, I never knew there was so much difference here.
We use PICC lines all the time for draws, in fact, our protocol states that if a patient has to be stuck more than four times for the anticipated hospital stay, has inaccessible peripheral locations, or poor perfusion in the extremities, or disoriented and threaten a peripheral site, or on a ventilator, the PICC line goes in. We do use a 10 cc syringe, draw 7 cc, discard, draw the sample up to 20cc, and then flush with NS 7cc. No collapsed lines, and better infection control. All meds given must be given with at least a 1 to 3 ratio of NS, over 3 minutes.
Mar 8, '03Another NICU here....we only draw off for cultures,nothing else...we have lost one too many lines from clotting. We also use a 5-10 cc syringe as advised by the manufacturer. We aren't supposed to use a TB syringe...it exerts way too much pressure.
Mar 8, '03Originally posted by JNJ
Incidentally, anyone out there with a line older than 18 months? What's the record on this?
Mar 8, '03End of discussion. They are the ones who say yea or nei.......I have bigger fish to fry.
Mar 8, '03Is this the MD's preference known to the staff, or is it written as order on patients chart?
Mar 8, '03Agree with above posters: Lab draws can be done on any PICC
4 FR or greater using 10cc syringe. Purpose of PICC is to SAVE VEINS!
QUESTION: What syringe size is recommended for use with various catheters?
ANSWER: It is recommended that a 10cc syringe or larger be used to infuse or flush catheters. This includes Pediatric and neonatal catheters. Infusion pressures should never exceed 25 psi because pressures higher than that may damage blood vessels and viscus. A two-pound weight equivalent force on the barrel of a 3cc syringe generates pressure in excess of 25 psi. The same two-pound weight equivalent force on the barrel of a 10cc syringe generates less then 8 psi of pressure. Please refer to the Instructions for Use for further details.
More info here:
Vascular Access Infections in the Outpatient Setting--Power Point Required
eMedicine - Venous Access Port Problems : http://www.emedicine.com/aaem/topic472.htm#target1
Patient advocacy alert!!!!
Sounds like many nurses need to check with the manufacturer of IV device being used in their facility for education on devices and use to discuss concerns with prescribing doctors and creating up-to-date policy and procedures!