Drawing Blood From PICC Lines

JNJ · Feb 3, 2003

Any chance there is confusion over PIC (peripherally inserted line) and PICC (peripherally inserted central line). Otherwise mjlrn makes sound statements. However, if the docs. and protocol are not sensible, it's up to the RNs to work up a presentation for change.

I recently accessed CDC guidelines for PICCs and they were surprisingly unspecific (related mainly to infection control issues.) So back to the manufacturer of the line most commonly put in in your unit. Can the rep. help you here? The flushes/waste blood amount mentioned in above posts sound huge to me. The volume in these lines (in pediatrics) is really small, around 0.3 ml per manufacturer.

Absolutely agree with nothing less than a 10cc syringe. Both pushing in and pulling out, smaller syringes create more pressure. I've demo'd this to students with a removed line.

I now work with an 18 month old PICC line with two ports which is maintained on a 30 lb child with obsessive attention to technique. We draw blood x 2 weekly, small pre and post flush of saline. Patency is maintained with q24h with 3 cc heparin. Valve change q3 days. 10 cc syringes. I cannot imagine managing her care without a PICC.

Incidentally, anyone out there with a line older than 18 months? What's the record on this?

Jay-Jay, RN · Feb 4, 2003

Voumes 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.

KRVRN, BSN, RN · Feb 4, 2003

With 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.

New CCU RN · Feb 4, 2003

RN'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!!!!

emily_mom · Feb 5, 2003

They 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.

passing thru · Feb 14, 2003

We 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 .

deespoohbear · Feb 14, 2003

We 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....

Cafe · Feb 14, 2003

We 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!!!

Glad2behere · Feb 14, 2003

Gosh, 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.

NicuGal, MSN, RN · Mar 8, 2003

Another 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.

emily_mom · Mar 8, 2003

Quote
Originally posted by JNJ

Incidentally, anyone out there with a line older than 18 months? What's the record on this?

Just had an oncology pt the other day who's line was 2 years and 3 months old. She was very attentive to sterility when we were drawing on it. Don't blame her...it's her lifeline...:)

renerian, BSN, RN · Mar 8, 2003

End of discussion. They are the ones who say yea or nei.......I have bigger fish to fry.

renerian