blood draw from PICC

[littlegreenfrog]

Ok, I know this is a simple thing, but how do you draw blood from a PICC? This is how I do it:

Flush PICC with 10cc saline then pull back 10cc blood (to waste)

Hook up that vacuum-thing and put the blood into the tubes

Flush with 10cc and change the end piece (cap thing) of the PICC

Am I doing something wrong? (I left out obvious parts like wash hands, glove, check armband, swab with alcohol, etc)

Also, if a pt is getting a heparin drip, can you draw from the PICC or do you always do a peripheral blood draw for Ptt? If you do draw from PICC, how long do you stop the drip for before?

Thank you - when I ask my fellow nurses I get a million different answers and I can find no place where hospital protocol is written (I work at a s h i t hole of a disorganized place)

[Sun0408, ASN, RN]

I clean with chloraprep, flush with 10 cc NS, draw my waste, attach a new 10 cc syringe to get my draw. I then flush the line with a separate 10cc NS, flush the new cap, remove the old cap, then attach new cap- flush.. I stop everything just before getting my sample no matter what is running.. If something is running that may give me a false reading I will flush with 20 cc NS then a waste, then get my sample.

I typically use 3 to 4 10 cc NS syringes..

[MunoRN, RN]

The CDC and manufacturers recommend not changing the cap with every blood draw, but rather weekly and prn (changing the cap poses an infection risk and changing that often is unnecessary). We draw using syringe and then use a transfer device, mainly because our policy is to send no more blood than necessary and a syringe allows you to measure accurately. I stop the fluids for just a few minutes before drawing, remember there's a few liters per minute flowing by the tip of the catheter which will clear the IV fluids fairly quickly. Our policy is that you can draw a ptt from a PICC infusing heparin but not from the same lumen as the heparin.

[0402]

I was taught not to attach the transfer device directly to the PICC d/t it possibly collapsing the lumen from the vacuum pressure; I always use a syringe to draw the blood. I was also taught to flush with 20cc and to do it in a pulsating manner, to help with getting the blood off of the inside of the lumen and keep it patent. I also stop everything before drawing. If it's heparin, I usually stop for no less than 10 minutes. If it's just fluids, I just turn it off to do the draw.

[Altra, BSN, RN]

Agree - don't use the vacutainers with a PICC. I turn off Heparin for 10 minutes before checking a PTT, and I draw that from a separate site from where it is infusing, even if it means another peripheral stick for the patient.

[MunoRN, RN]

One thing to remember about heparin is that it has a very short half-life, so stopping the infusion for too long could significantly alter the ptt results. Again, with a central line after only a minute a couple liters or more of blood will have flowed by the catheter tip, making 2 or 3 minutes more than enough time to flush the drop or two of heparin the would have infused in the last few minutes.

I'm not sure why you would stop the infusion at all if you are drawing from another site all together, unless you are drawing downstream from the infusion.

[Altra, BSN, RN]

Heparin's half life is approx. 90 minutes.

RxMed: Pharmaceutical Information - HEPARIN

[MunoRN, RN]

IV heparin half-life is dependent on a variety of factors and can be up to 90 minutes, although it's more often quoted as 60 minutes and can be as short as 30 minutes: Anticoagulant Therapy Monitoring

10 minutes probably isn't a big deal, but having it off "for no less than 10 minutes" probably isn't a good idea, rather for no more than 10 minutes is probably a better rule, although still probably unnecessary.

[Altra, BSN, RN]

LOL Muno, not going to get into a "my source says this, your source says that" ... My experience is that everywhere you work, there are protocols put in place based on available research and the professional perogative of those who set policies.

Another poster used the phrase "for no less than 10 minutes".

[littlegreenfrog]

Thank you - never thought about the vacu-thing collapsing the vein, will not use it anymore.

[vwde]

At my facility, the policy is to stop the heparin gtt for 5 minutes, flush (10 cc), waste (10 cc), sample (10 cc syringe, but usually only take 4-5 cc), and flush (10 cc).

[MattNurse, MSN, RN]

Turn off all of the drips/fluids for 2 minutes before drawing. Swab w/ alcohol the port and the tops of the tubes. Then I draw back 7 ml of blood from the proximal port. Prior I add up the milliliters on the tubes, lavender and green usually 4ml each, so draw up 8 ml of blood, then flush w/ 10 cc of saline, then flush w/ 2ml of 200U/ml heparin and clamp. Then transfer syringe blood to tubes. Then I restart all the drips/fluids.