Does your phlebotomist ask you to draw blood from a PICC line for them?

[koinurse]

Hello fellow nurses! I recently transferred to another SNIF as an 11-7 RN and in the am, the labs phlebotomist would keep asking me to sign papers that the pt refused to have blood drawn, and I would go to the pt's room and ask them myself, and they always agree if its me asking ( this in the middle of med pass). I was just particularly irked today because last night was very busy, then at around 6.45am the labs called me to say that the phlebotomist would be late for 20 mins and to hold the residents' breakfasts until she comes! So I go, ok I got all the names of the residents with blood tests and asked the CNAs assigned to hold it (we are on full census!) So here she comes( while I was counting narcs with the incoming nurse) asking me to sign the lab again that the pt refused! I asked her what lab it was, and it was a PT/INR, so no way Im going to allow the pt not to have it. So off I go to ask the pt again, and she agreed, and the phleb brushed me aside(as usual!) saying, "I'll take it from here". Then I was counting with another cart and she interrupts me again saying that another pt with a PICC line wants her blood drawn from her PiCC line, and that I should do it because Im the RN! I absolutely am not comfortable drawing blood from a PICC line, there is so much policy to follow ( 2 pages long) and the pt has good veins! ( someone had informed her that since she is a hard stick, everything can be done with a PICC line). For me, the risks far outweighs the benefits (mainly the pt's comfort and the phlebs' time! sigh...) I hate losing my patience, but off I go to the pt again and asked her to have blood drawn from her other arm, and she said yes! Then here she goes again with her "I'll take it from here" line. I keep losing valuable time with this phleb because I needed to endorse my narcs, and do some more charting! My question is, do your lab rep ever do this to you? The phleb in the previous facility I worked at never asked me to do this! Im just venting and I do like to hear your views. Many thanks in advance!

[Freedom42]

Phlebotomists at my facility are not permitted to draw anything from a PICC. So yes, I do it all the time.

I'm puzzled by your post. What risk of using the line outweighs the benefit of patient comfort? Why wouldn't you use a functioning line that's already been installed?

[Sun0408, ASN, RN]

At my hospital if the pt has a PICC line or a TLC, the lab is not allowed to stick them. The lab is not allowed to pull from the PICC or TLC either. They leave us the tubes and we pull them and send them down.

[grandmawrinkle]

This is common practice in hospitals. Phlebotomists cannot access a PICC because they are not trained to do so. Usually the nurses do the line draws for the lab. I don't know why you would put a patient through a stick in the arm when they have a PICC line.

[island40]

I've even drawn from Dialysis Hickman lines (certified dialysis nurse and no way going to get a vein unless you want to try sublingual). If you have a line that doesn't have a ton of heparin in it so that you have to waste a lot of blood that the patient doesn't have - why do a stick?? Sorry, but you are not going to win on this one.

[JennDRn]

As a former Phleb, I can say that we were not allowed to access picc lines. That is the RN's job. It would infuriate me when a nurse would give me attitude about it. Many of these patients with picc lines have them because they have poor venous access or frequently ordered blood work. I would also get upset when they would cancel a ptt that was ordered for routine 4 am rounds and then not cancel the other routine order (cbc, cmp) so the lab would draw these tubes and then get a stat order 2 hours later for the ptt. So the patient is getting stuck 2 times in two hours instead of having all of the tests done when the ptt was ordered. So much for minimizing blood draws for patients on heparin. And please don't think I don't understand that sometimes blood test are ordered after the routine bloods are drawn, however this happened frequently at the hospital I worked for as a phleb. Very disorganized, and certainly not putting the patients needs first.

[LouisVRN, RN]

Ugh I totally agree working in a hospital, I tell my patients with a PICC line NOT to let lab draw them.

[DogWmn]

I'm also a phlebotomist and we are not allowed to draw from anything other than a peripheral vein, you might ask your pt's if they don't mind a blood draw from a vein, but they might feel they are getting stuck enough and would prefer it done through their PICC. I have crap for veins and I know if it was me I'd prefer it done through a PICC.

[koinurse]

Thank you for your replies. Just to clarify that the post was meant to say that the phleb would rather have me sign that pt refused rather than try to get the pt to have a stick. We are not a hospital, so our pts do not get sticks all the time. Im just comparing because at the other facility I worked with, the phleb was hospital - based and he got all his labs on time and never a problem with his sticks, even having the time to be nice to the patients, that is all. Again thanks!

[JennDRn]

koinurse, I'm sorry. I hope you didn't take my post the wrong way. I do agree that if patients are refusing this phleb more than others that perhaps there is a problem with that particular phleb. I must admit that as a phleb I would sometimes have pts refuse me and the RN would go in and talk to them and they would agree and make me feel foolish =) Same thing happens now, when they refuse me and the MD talks to them and they agree =) Vicious circle!!

[shiccy]

As others have said one of the big purposes of having a PICC line is to be able to draw off of them. What needs to happen in your case is you need to sit down and honestly take the time to do a quick read through of the protocol, and after you think you understand it, have someone show you HOW to do this.

In order to ensure you have a properly working PICC line you must perform a flush AND get a blood return every (typically) 12 hours. Many places this is every 8 hours. If you don't get a blood return, then your PICC needs to go through declotting with TPA by a certified person to do so.

Pulling blood off a line is just like accessing an INT or even a phleb draw for the most part, it just involves flushes...

If you have a heparinized line you will obviously need to do a bit of aspiration of the line. The PICCs *we* use don't require heparin, but it is a possibility. Also, some places have you place the blood back after you're done, ours discourages this. Finally, the above is *generalized*, READ your protocol, and ask someone to help!

Finally, not doing something because you "don't know how" or "the protocol is 2 pages long" is not the greatest excuse in the world. Educate yourself, ask someone ELSE to help with your education afterwards, and after three or four draws you'll have the knack!

With you accessing this line you're saving a phleb draw and potentially saving future veins for IV's and infusions if needed. *we* don't use them for accuchecks unless we're already taking blood for labs. Otherwise we poke... Please don't have phleb draw a patient peripherally when they have a PICC. It's there for a reason, use it! (And be that much nicer to your patients!) :)

[Bumashes, MSN, APRN, NP]

We draw from PICCs all the time on my floor. Pull out blood to waste and then draw your blood. Flush and lock with saline, unless your type of PICC requires heparin, then flush with NS and lock with heparin. Phlebs aren't trained/certified/qualified/whatever to access PICC lines. Sounds like they're just lazy besides. If so many pts supposedly refused but then accepted when another asks, then that tells me that they're asking in the wrong way. Probably on purpose. We used to have an aide who would go in pt's rooms while they were eating breakfast and ask if they wanted a bath. Of course they said no b/c they were eating. But then she would go and chart that they refused a bath. Dorks.