Drawing blood from a PICC line

[rnewmanjunkie]

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......

[Dolce, RN]

I think the rational for not drawing certain drug levels through a PICC is that it may cause a false high. For example, if a patient is receiving vanco through a PICC line and then a peak and trough is drawn on the patient very small amounts of the drug may still be left on the inside of the catheter, skewing the results.

[Mulan]

I think the rational for not drawing certain drug levels through a PICC is that it may cause a false high. For example, if a patient is receiving vanco through a PICC line and then a peak and trough is drawn on the patient very small amounts of the drug may still be left on the inside of the catheter, skewing the results.

right, but if the PICC is the only place to get the blood from, then one has no choice

[caroladybelle, BSN, RN]

Some places will refuse coags drawn from any central access.

Research has shown that the results may be altered, both from heparin having been instilled in the VAD, as well as bodily/venous response of clotting factors to venipuncture vs preexisting line. Since most tubes are calibrated based on resulting from a venipuncture, results from a VAD draw may not be accurate.

[janetjanetbobanet]

one big thing is you NEVER directly attach blood culture bottle to the picc. The culture medium in the bottle is deadly if it gets into blood stream.

I didn't know this about the culture medium, neither did most of my co-workers. But then we always use 10cc syringe for wastes, draws, and flushes so it hasn't been an issue.

[dardeedee]

Don't pull back too hard, take it easy. You will collapse the line. I compare it to backing a car out of a driveway with a house on one side and the neighbor's car on the other. Just ease the blood out of there and don't get into a hurry.

[Mulan]

Some places will refuse coags drawn from any central access.

Research has shown that the results may be altered, both from heparin having been instilled in the VAD, as well as bodily/venous response of clotting factors to venipuncture vs preexisting line. Since most tubes are calibrated based on resulting from a venipuncture, results from a VAD draw may not be accurate.

okay, so what if one (or no one) absolutely can not get blood from any other source?

[caroladybelle, BSN, RN]

okay, so what if one (or no one) absolutely can not get blood from any other source?

I've had MDs so adamant that they ordered art sticks.

It depends on how essential the need for the blood and accuracy of results.

[kcalohagirl]

Very rarely, have I seen a patient that you can't stick them anywhere. You may have to get a bit creative. In the past, I had one patient that the only IV we could sink was in her right upper chest.

We use PICC lines for all normal labs. (If the patient already has a PICC, of course.....) Why put the patient through the pain of an extra stick if we have a central line?

If we need blood cultures, we take one from the central line, then one from a peripheral stick.

We do a 10 cc flush, a 10 cc waste, draw what we need, then a 20 cc flush, clamp it, and we're done.

[clayah]

Can PICC lines and CVC's be clamped? We used to clamp them all the time when not in use to prevent air embolism if cap falls off. However, I am reading clots can form if lines are clamped. Can anyone enlighten me about this?

Thanks.

[iluvivt, BSN, RN]

The INS recommends only the syringe method to draw blood from PICCS,although I have used a vacutainer on occasion.

[robby5313]

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

Yep, it can leach into the line causing high results! I work in Home Care and we always draw everything but drug levels from PICC lines.

[cb_rn]

@ what to do if you can't get blood from anywhere else...

we call a doctor or a PA to come do a femoral stick