drawing blood from picc line

highlandlass1592, BSN, RN · Feb 14, 2009

If done properly, you can definitely draw from a Picc line (unless it's against policy of course). One thing to keep in mind is that on some Picc lines you should only use a 10 cc syringe to draw back with..has to do with the pressure exerted on the line. Here's a link for Picc lines we use at my facility..they have nursing info that may help you: http://www.bardaccess.com/nurse-powerpicc.php If that isn't the Picc your facility uses, they have links for other types of products you may utilize. It's easy to find out what type of Picc your facility uses, usually they throw a card in the patient chart (or if you utilize an IV team, they can always supply the info to you).

As for not being able to aspirate blood from a Picc, it could be a pressure issue from not using the right size syringe....you should never use a vacutainer to draw blood off a Picc. Or you could have some fibrin at the end of your line which may require it to be declotted. Those are the most common things I can think of. Hope any of this helps.

americanlatina313 · Feb 14, 2009

i have drawn blood off of a picc before without any problems. sometimes some of them don't do well for blood draws, but most of the time there's not a problem (that i have seen).

RochesterRN-BSN, BSN, RN · Feb 14, 2009

The two tricks I have found help are to have the patient lift the arm up --along side the head, and also one the PICC team told me is to have the patient turn his or her head away from the side the PICC is on.......I have done both at once and got blood...........Also We didn't flush first before drawing as that might dilute the blood. We cleaned, withdrew a good 5-7 cc of blood (ALWAYS in a 10 cc syringe or larger) and that first blood got wasted, the the next tubes after can be saved and used, again drawn with a 10 cc syringe or a couple if you need. Then flushed with 20cc of saline then if required heprin. (Some need it some don't--its been a while since I used one, but I think the open ended ones with the clamps get heprin and the closed ended don't need heparin--but you should know which you have and if your hospital uses heparin for what you use)....

When you waste the first blood you are also getting rid of the blood that has heparin in it-- if this is a line using heparin, of course.

So try these tricks and see if they work.

NeosynephRN · Feb 14, 2009

Some PICC's can be positional...try to have the patient move their arm like PsychRn suggested. Really in some patients access to blood for draws is a reason to put in a PICC, some have no place left to stick for peripheral draws, and with some of our patients getting labs every 4 hours a PICC or reg central line is a blessing!!

We always flush with 10cc's saline first and then withdraw and waste 10 of blood. Draw amount needed for labs and flush with 20cc's of saline. We do not use heparin to pack anymore, we use the Solo Power PICC and they are designed to use saline only!

lpnflorida · Feb 14, 2009

The Picc line many very well be so called positional as already pointed out. When all has failed we call the IV team ( they are the only ones in our facility who are able to give the 2cc of tpa used to unclogg the line)

We have been told not to wait to call them as the sooner they are declotted the better chance they have of saving the Picc line.

An aside. Mediports you can have the patient turn away and cough, this also can be helpful when attempting to access and get a return.

mommyX2 · Feb 14, 2009

Watch your caps too. Some caps don't let blood through as well as others.

kmoonshine, RN · Feb 14, 2009

Before I access a PICC, I ask the pt why they have a PICC in the first place.

If they can tell me why they have it and what is capped in the line, then I will access it (however, I am hesitant to access PICC lines if it's used for chemo, since it is necessary for medication treatment and accessing their PICC puts them at increased risk of infection). But if the pt has no clue about their PICC or what solution is used to cap it, then I hesitate to access the line.

I had a CHF pt come to the ED who could not tell me why he had a PICC line; "so they could give me medication, cause my veins are bad". And as I look down, I could see veins that could take an 18g anyday. I ask "what medication?"; he responded "I dunno." (I looked it up on the computer - and he's on natrecor for CHF). I asked him "do they put medicine in the PICC when they are finished with it, so it doesn't clot off?"; he says "I don't know." The caps of his PICC were covered in adhesive; the dressing was not transparent and was basically tape wound around his upper arm. I initially called lab to draw peripheral labs, but the charge nurse stepped in stating "we access all PICC lines - you must access his PICC."

I don't like touching a PICC in the ED if the pt can't give me a good history on why they have it. I think it is a pt's responsibility to know a little SOMETHING about the tube hanging out of their arm; and I don't feel that it is best to access a device which has an unknown purpose (kinda like jumping without looking). Obviously, in an emergency situation (ie code), the rules change; but if someone comes in with no knowledge of their PICC, then I hesitate to access it.

Now, if someone has a PICC because they have sickle cell and they come to the ED because they are having a sickle cell crisis, by all means I will access it. I use a chloroprep to cleanse the cap (I usually just change it out and give them a nice fresh cap), I use a 10mL syringe and draw off 8-10mL for discard (or use it for cultures, if indicated), then I draw labs using a 10-20mL syringe, and then I flush well with 10-20mL saline (using push/pulse technique) and hook their PICC up to normal saline on a pump at 75mL/hr during their ED stay to keep it open for meds and fluid administration. If I can't draw blood off their PICC line, I ask them to raise their arm up, lean forward, cough, turn on their side, etc. This may or may not work.

I am amazed at how many people come to the ED with PICC lines, who cannot tell me why they have it. Seriously...

HappyBunnyNurse · Feb 14, 2009

Unless specific policy states otherwise, use that PICC! If it is an ER or from an outside hospital then placement should be checked (by x-ray). But if it is ok for meds and policy doesn't state otherwise spare your patient the stick. If you can't get blood return after moving the patients arm all around and raising the HOB then you probably have some fibrin growing. When the fibrin first starts you can get fluid in but not blood out because the fibrin acts like a flap. You need to get an order for Cathflo or something similar. The main thing to remember about picc lines is FLUSH! Flush before meds, after meds, before draws, after draws, and at least once per shift. And teach the patient to flush at home. A stopped up picc not only means lost access but also is a breeding ground for infection. I did heme/oc for a while so I know picc lines can be frustrating but I don't know what those patients would do without them.

AirforceRN, RN · Feb 14, 2009

I agree with above regarding flushing. I don't think there is any reason not to flush before drawing blood. Diluting the blood would only be an issue if the patient had a heart rate of....say...5.

Virgo_RN, BSN, RN · Feb 14, 2009

today i had to draw blood from picc line. but my manager said shes going to try to draw blood peripherlly because she didnt want to mess up the picc line? is this true that drawing blood from picc line can easily mess up the picc line? then i tried to draw blood from picc line and i flushed with saline first then tried to withdraw blood from picc but i'm not drawing any blood? if picc line is in superior vena cava, why am i not able to aspirate blood? is there a tip on how to draw blood from picc? thanks:lvan::lvan::[anb]::[anb]:

we draw blood through central lines all the time. as others have mentioned, always use 10cc syringes. anything smaller exerts too much pressure on the catheter, increasing the risk of damaging it. if you can flush but cannot get blood return, it could be positional, as others have mentioned, or there could be a little fibrin flap at the tip preventing blood from being drawn back up. if it's a dual or triple lumen picc, just try another lumen. if it's a single, then at my facility, we'd call in iv therapy.

having said that, policy at my facility is that you aspirate for blood return prior to flushing. if you cannot get blood return, do not attempt to flush.

BradleyRN · Feb 14, 2009

There is no sense in sticking someone if they have a PICC!