Drawing blood from picc, air? collapsed lumen?

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Hey all

I've never seen this happen but I went to help a new nurse who couldn't get blood very well from a PICC. It was a double lumen and she was drawing from the brown lumen and she got a little blood in the syringe but it wouldn't draw more. It was greating a vacuum in the syringe and then there would be breaks in the blood flow with air?? or something similar. I've never seen in my life and it made me nervous. I tried the other lumen and it drew fine. My question is: On the first lumen she tried, if it was collapsing when she drew blood WHY on earth would there be clear areas in between a little blood flow like it was air? That seems impossible. I was worried about catheter migration but the other lumen drew fine.

Thanks

Z

HeartRN_09, BSN

109 Posts

Specializes in Cardiac step-down, PICC/Midline insertion. Has 10 years experience.

If you ever have trouble drawing blood from a picc you shouldn't force it. Sometimes it's positional and you just need to move the arm a bit, there could be a small clot inside, or there's a fibrin flap over the catheter opening that's being sucked in preventing blood aspiration and the line just needs cath flo to break up the clot/fibrin flap. If all of these measures fail, you should get an X-ray to see where the tip of the picc actually is. If you continue to try and aspirate blood inside the lumen and it sits there long enough without moving you can clot the entire lumen off and the picc is basically ruined at that point and would need to be replaced.

As far as there being air in the line, I think that was simply from the suction of the syringe separating the blood into sections because it wasn't easily flowing. I doubt you were pulling free air from the line....that would be a sign the catheter is no longer in the vein, but since the other lumen drew easily, it clearly was still in the vein.

zacarias, ASN, RN

1,338 Posts

Specializes in tele, stepdown/PCU, med/surg. Has 14 years experience.

Thanks for your comment. I think you're right. I also believed it was a fibrin sheath that was preventing easy flow. the part that freaked me out was that there'd be a little blood flow in the picc tubing and then a break with nothing and then more blood. I just have a hard time wrapping my head around that as far as explaining it. Thanks!

Z

iluvivt, BSN, RN

2,773 Posts

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

You could have a pinpoint hole or fracture in any part of the catheter that is externally visible on that lumen.These tend to happen after somone has administered cath=flo and pushed too hard or someone forcing a flush or any IV medication.Check to see if any given in last 48hrs as often they occur because the catheter is initially weakened then develops the hole as it is used.The most likely cause is that you have a partial thrombotic occlusion...able to instill but not easily withdraw or withdraw at all.You always want to treat this.