Drawing blood from a PICC line

Nurses General Nursing

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Is there a better way to draw blood samples from a PICC line other than drawing the sample in a syringe and transfering it to a vacutainer tube? Thanks......

As an oncology nurse our pts have either piccs or some kind of central line (ie. hickmans, groshongs) or a permacath. I use vaccutainers with all blood draws, unless I cant get any blood back and then I will try to used 10cc syringes. If that doesnt work and we cant get ANY blood back we will TPA the line....but thats another story.

Specializes in ICU/PCU/Infusion.

I dunno. I usually say no when asked to draw from a PICC. I tend to err on the side of caution. I don't want the line to clot, or have skewed lab results from some med that has been infusing prior to my draw. (think potassium infusion and then lab draw for potassium level??)

I know there are nurses that draw from PICCs everyday, but unless I know the pt. is an incredibly hard stick, I let the lab do a peripheral stick.

Any thoughts on this?

Specializes in Neuro/Med-Surg/Oncology.

The clotted line can be treated with Cathflow, if necessary. Also, when you waste the first 10mL of blood and flush with 10-20 mL of NS, any blood with the immedialy infused meds/supplements should not be in with what you're sending to the lab. One thing that happens w/PICCs occasionally is a high K level because the cells have hemolyzed. That has happened twice in the time I have been working and they were other nurses' patients, so it's really not that often. Also, now that I am thinking about it, why are you drawing a K level while the supplement is still infusing? That's like sending a CBC while blood is hanging. I wouldn't subject the patients to unneccessary peripheral sticks, but that's me. Check with your facility's p&P.

Specializes in ICU/PCU/Infusion.
The clotted line can be treated with Cathflow if necessary. Also, when you waste the first 10mL of blood and flush with 10-20 mL of NS, any blood with the immedialy infused meds/supplements should not be in with what you're sending to the lab. One thing that happens w/PICCs occasionally is a high K level because the cells have hemolyzed. That has happened twice in the time I have been working and they were other nurses' patients, so it's really not that often. Also, now that I am thinking about it, why are you drawing a K level while the supplement is still infusing? That's like sending a CBC while blood is hanging. I wouldn't subject the patients to unneccessary peripheral sticks, but that's me. Check with your facility's p&P.[/quote']

I was just using that as an example. I wasn't saying doing the draw WHILE the K was infusing.. I guess it was a bad example. :blush:

Anyway, our facility allows it to be at the RN's discretion. The IV team, on the other hand, really really really doesn't want us drawing from "their" PICCs.

Like I said, I will do it if the pt. is a hard stick.

Thanks for your reply!

Specializes in Med-Surg, Wound Care.

I know there are nurses that draw from PICCs everyday, but unless I know the pt. is an incredibly hard stick, I let the lab do a peripheral stick.

Any thoughts on this?

My previous hospital we drew from PICC lines ALL the time. The lab did venipunctures.

My current hospital has a PICC team that does ALL draws from a picc line. We, RN's, LPN's and techs do venipunctures.

Specializes in Neuro/Med-Surg/Oncology.
I was just using that as an example. I wasn't saying doing the draw WHILE the K was infusing.. I guess it was a bad example. :blush:

Anyway, our facility allows it to be at the RN's discretion. The IV team, on the other hand, really really really doesn't want us drawing from "their" PICCs.

Like I said, I will do it if the pt. is a hard stick.

Thanks for your reply!

Sorry . . . . . I didn't mean to put you on the spot or criticize.:kiss By flushing and wasting, you should be fine re: any residuals of meds or supplements. Will your IV nurses come up and draw the labs for you if they don't want you to mess with "their" lines? They should. I know if our blood team sees a central line, they don't draw unless there's a problem with the line or we need blood cultures from multiple sites.

Specializes in ER, ICU, Infusion, peds, informatics.
you never want to "pop the top" off of a vacutainer tube. if you let the vacuum draw the sample from the syringe, then you get the proper amount of blood to anticoagulant and remove the dilutional factor. coagulation tubes must be filled properly or the results are invalid. also, when you remove the stopper, the stopper can come in transport contaminating an entire transport system.

the amount of blood required for each tube is written on the tube. not difficult at all to make sure you get the correct amount into them, even for the coag tubes. our blue tops require 4.5cc of blood per tube. our purple tops require much less. and the ssts only require enough to "spin" and have enough serum for each test.

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[color=#483d8b]i know the stopper can come off during transport; that is why i wrap them in parafilm before i ship them. haven't had one come off yet.

Specializes in ER, ICU, Infusion, peds, informatics.
i didn't know you could hook a vacutainer directly to a picc line. how does this work?? do you use the vacutainer transfer device to do it? i'm having trouble visualizing this one. at my facility, you use a 10cc syringe and you have to waste the 1st 10cc syringe (unless you're drawing blood for blood cultures).

if you have an old-fashioned style heplock cap, then you just stick the needle into it.

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[color=#483d8b]if you are using a needleless system, there are special vaccutainer "needles" that have a blunt tip on the end that goes into the heplock cap. they are blue (while the 21g needles are green and the 22g needles are black). i'll see if i can find a picture.

Specializes in ER, ICU, Infusion, peds, informatics.
sorry . . . . . i didn't mean to put you on the spot or criticize.:kiss by flushing and wasting you should be fine re: any residuals of meds or supplements. will your iv nurses come up and draw the labs for you if they don't want you to mess with "their" lines? they should. i know if our blood team sees a central line, they don't draw unless there's a problem with the line or we need blood cultures from multiple sites.[/quote']

actually, the materials that most central lines are made of today are not completley biologically inert.

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[color=#483d8b]polyurethane (which most our our central lines --- both traditional and picc -- are made of today) tends to "hang on" to water-soluble drugs. silicone, on the other hand, tends to hold on to lipid-soluble drugs. (silicone isn't as strong, and isn't used as much anymore).

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[color=#483d8b]how much drug do the catheter walls tend to hang on to? probably not all that much. however, enough that can make me question any elevated levels. when i worked in icu, the turn-around time was fast enough that i felt it was ok to "risk" drawing from a line. however, in home-care, i never draw labs from a line that could "contaminate" it -- such as drawing a vanc level from a line that vanc was infused through. the turn-around time is just too long (>24 hrs) and therapy is impacted too much to risk it.

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[color=#483d8b]so......i guess my point is this: if i were you, i'd continue drawing from the line in the in-patient setting. but, if i got an elevated k+ level back from a line draw, and kcl had gone through that line.......i'd have lab double-check with a periperal stick before giving that k-exylate.

Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

I have always used the PICC for lab draws if the patient has it because it saves them a stick. I always waste 10 cc and then draw my labs. I thought that the only thing that couldn't be drawn through the PICC line was drug levels (eg., vanco). You could have a falsely elevated K+ from hemolyzed blood, but that can also occur with too forceful of suction during a venipuncture as well.

Specializes in ICU, Research, Corrections.

I would much rather draw from a PICC or central line any day than a peripheral stick. I will even draw from an 18 guage or 20 guage IV if it will draw.

Follow this up with a 10 cc flush after drawing to prevent clots.

The key is to always pause whatever you have running through the pump to avoid contamination. Then flush with a 10 CC syringe of normal saline. Then withdraw 10 cc of blood with the syringe as waste. Put the vacutainer , (one with a blunt tip in a needless system), in the end of the PICC line and blood flows out to fill your tubes. With this method you have no needles at all involved.

I never have problems with hemolyzed blood through a PICC. I have with an IV though.....you have to make sure you have quick blood flow if you are using a plain IV.

Happy blood drawing

I have always used the PICC for lab draws if the patient has it because it saves them a stick. I always waste 10 cc and then draw my labs. I thought that the only thing that couldn't be drawn through the PICC line was drug levels (eg., vanco). You could have a falsely elevated K+ from hemolyzed blood, but that can also occur with too forceful of suction during a venipuncture as well.

why can't drug levels be drawn?

the reason why a lot of patients have PICC lines in the first place is because they have no veins and can't be drawn otherwise, you can't get blood out of a turnip

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