Blood draws from a PICC/midline

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I am having a bit of difficulty drawing blood from a midline. I flush with 10 cc of normal saline(no problems), but when I start to pull my waste I do not get a return. I have had this happen twice. Has this happened to anyone else? Am I doing something wrong? Any tips of the trade? Will the questions never end?

Rachel RN

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

This is from Nursing 2004 and it addresses this:

http://www.findarticles.com/p/articles/mi_qa3689/is_200402/ai_n9385672

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You can draw blood from a CVC using the discard method with direct Vacutainer connection or a syringe or using the push-pull method with a syringe.

It's been a while since I've done blood draws, but at the time we were not allowed to use PICCs for draws.

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Specializes in Cardiothoracic Transplant Telemetry.

At my institution we are able to draw from regular PICC's with a doctor's order, but midline PICC blood draws are not allowed. My understanding is that midline PICC's were not able to be threaded all the way to the subclavian as is preferred, and so are acceptable for infusion, but not for blood draws. I hope this helps

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I have alway been taught if you can flush it it is in the right place, if you can't get a blood return it may be positioned against a side of the SVC or there is a fibrin sheath that grew over it and it needs to be tpa'd! probably tpa is needed ! Good luck!

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I didn't think drawing from midlines was an option? Anyone have any info on this?

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obtaining routine blood draws from a midline catheter is contraindicated. The tip of a midline lies in the upper deltoid or axillary vein. The only acceptable tip location for a picc line is the lower segement of the superior vena cava.

So to answer your question, you should not obtain blood specimins from a midline. You should also refrain from obtaining blood from smaller lumen piccs as well.

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Specializes in Med-Surg, , Home health, Education.
LisaRn21 said:
I have alway been taught if you can flush it it is in the right place, if you can't get a blood return it may be positioned against a side of the SVC or there is a fibrin sheath that grew over it and it needs to be tpa'd! probably tpa is needed ! Good luck!

I don't know that I would go with positive placement just because you can flush it. I've seen lots of peripheral IV's that are slowly infiltrating that are easily flushed. I would agree that it's possible to have the fibrin sheath. I have used different arm positions if I can't get a blood return and this sometimes helps.

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Bob is correct...blood should only be withdrawn from PICC lines that are 5 fr or larger. We flush with 10 cc of NSS and then withdraw 7 cc for waste. After you get your blood then flush again with 10 cc NSS and 3 CC of Heparin...be sure to change the cap after blood draws as blood can clot the caps. Blood Cultures should always be drawn peripherally..if the pt has poor access then try to get at least one set peripherally and one from the PICC line. At the facility I am at currently we have a lot of problems with the lines flushing well but not giving good blood return..this could be from the lumen resting against the vein wall or people not taking proper care of the line. At another institution I worked at if a pt had a PICC that had to be accessed more than twice in 24 hr (which is most people due to antibiotics every 6-12 hrs) we had to have NSS running at all times at a KVO rate. Hope that helps! Good Luck!

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Specializes in Utilization Management.
hyperstudent said:
I am having a bit of difficulty drawing blood from a midline. I flush with 10 cc of normal saline(no problems), but when I start to pull my waste I do not get a return. I have had this happen twice. Has this happened to anyone else? Am I doing something wrong? Any tips of the trade? Will the questions never end?

Rachel RN

Our policy does not allow us to draw blood from midlines. I believe that it's not just because of lumen size, as mentioned in an earlier post, but also because the midline is made of softer plastic and it will collapse with the pressure of a draw.

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hyperstudent said:
I am having a bit of difficulty drawing blood from a midline. I flush with 10 cc of normal saline(no problems), but when I start to pull my waste I do not get a return. I have had this happen twice. Has this happened to anyone else? Am I doing something wrong? Any tips of the trade? Will the questions never end?

Rachel RN

Sometimes they just don't work well for us where I work. Occasionally you can get it work by moving the line and/or the patient's position around a little. As long as it flushes OK, then the line is still fine for infusions, you just have to poke the poor patient for blood :o .

And no, the questions NEVER end! That's the fun of nursing!

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And the red port on the picc line is always designated as the blood draw line. And as was noted above, the cap needs changed to that line after lab work and flushing is complete. I always use a collection holder and use smaller tubes so the suction is not so strong. If the patient has had any problems with their picc line as far as slow flushes, clogs that are cleared with heparin, I stick with venipunctures after that, not worth the risk.

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Question, Why not draw from a midline, a midline is the same catheter as a picc, usually a picc is attempted and if unable to thread through, the cath is clipped and the infusion team settles for a midline. As long as appropriate waste is discarded this would be the same as drawing and wasting from a peripheral site, of course blood cultures should be avoided from a picc or midline and should always be drawn from a new access site. If you know why some people are mentioning not to draw from a picc please let me know the rational for it. Thanks All, Zachary

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