Is it ok to draw lab from a PIVC?

Nurses General Nursing

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My floor is starting to have the ICU nurses draw their own labs. Usually the nurse would have the phlebotomists from the lab come up to do a venipunture, unless the patient had some sort of central line in place, then the nurse will do the draw. So now that we have to draw our own lab, most of the nurses are drawing from peripheral IV catheter (PIVC). I always thought that it was ok to draw from PIVC only upon the initial insertion of the catheter, and then you have to do venipunture thereafter. On a previous post, it was mentioned that “the blood that is near the IV is not good for sampling anymore because it doesn't flow/mix at the same rate” is that the evidence based answer? So my questions are:

1. What is the common nursing practice out there?

2. If it is common or uncommon to draw from PIVC: what is the rationale?

Specializes in ICU/CCU/CVICU/ED/HS.

We do NOT draw from the PIVC after the IV is started, we can, however draw at the initial "stick". What was explained to us makes sense (at least to me). As the catheter is in place in the vein, it warms and becomes somewhat softer and could collapse with the vacuum of either the syringe or the vacu-tainer. So... At our house drawing from an in-place peripheral IV is a big no-no. Other facilities may have different policies and procedures so, the usual disclaimer... Check you facility P&P manual.

There are PICC cathters that are designed to draw off. Check with your Materials Management Dept. They can contact Reps who can show you the newer product lines.

You're correct, when the PIV was just inserted it's absolutely OK to draw blood spec from it. After insertion it's no longer "adviceable" to get spec from the PIV because of risk of LOssing the site and extravasation. BUT when the ONLY way that a spec is obtainable is thru that PIV then use your judgement. You don't want to STICK your pt if he is not a candidate for phlebotomy. NOW if the pt has daily blood draw, say for... PT/INR, CMP, H/H, etc.. Then you as the nurse need to advice his attending M.D. to place Central line.

Specializes in Vascular Access.

Vpierre,

The appropriate thing to do is to assess what these nurses are doing, and compare it to accepted standards of practice. One such organization which sets standards for Infusion therapy is Infusion Nurses Society (INS). If a nurse were brought into a court of law for any issue r/t infusion, it's their standards which would be used as a benchmark for the practice of IVT.

INS standards state that peripheral IV catheters (those

Taking blood specimens during the dwell time of a peripheral IV catheter increases damage to the smooth tunica intima of the vein (which starts the process of phlebitis/thrombus).

In addition, this also results in your IV becoming problematic prematurely.

AND.... studies have shown that there is a much higher rate of hemolysis of the cells when performing this task which results in specimen rejection.

thank you for your replies which makes perfect sense. i did look on my p&p but could not find anything addressing this issue. i will e-mail my educator. anyone have anything more evidence base answers? thanks!

so far this is what i’ve learned:

1. blood sample taken from pivc have a higher rate of hemolysis.

2. drawing increase the risk of losing the site

3. it is common practice in pediatric patients and patients who have received tpa, and patient not candidate for phlebotomy.

4. “blood that is near the iv is not good for sampling anymore because it doesn't flow/mix at the same rate” (expathopeful, 2008)

5. “as the catheter is in place in the vein, it warms and becomes somewhat softer and could collapse with the vacuum of either the syringe or the vacu-tainer” (emboss, 2009).

Specializes in Oncology.

I'm interested in some of the responses here.

Firstly, a PICC is a type of central access- Peripherally Inserted Central Catheter. This is not something an RN can generally place independently. It is certainly not a new form of IV catheter that simply needs to be ordered.

Another poster said that a patient needing daily blood draws should get a central line. Don't most hospitalized patients get blood drawn at least once a day? Putting central lines in everyone is poor practice and not indicated.

I was talking about a peripherally inserted venous catheter (PIVC) not a PICC. Some people call it a prn adapter, iv, peripheral iv

Specializes in Vascular Access.
I'm interested in some of the responses here.

Firstly, a PICC is a type of central access- Peripherally Inserted Central Catheter. This is not something an RN can generally place independently. It is certainly not a new form of IV catheter that simply needs to be ordered.

Another poster said that a patient needing daily blood draws should get a central line. Don't most hospitalized patients get blood drawn at least once a day? Putting central lines in everyone is poor practice and not indicated.

With a MD's order, I place these every time I'm on call. I do it independantly, or without any assistance in its placement. Yes, I think we can agree that a PICC is different than a short term peripheral IV which is changed every 48-72 hours. This short term catheter is what the original poster was referring too.

we always draw from a picc line on our floor the lab techs are not aloud to draw from a picc. we wear gloves clean hub with 2 alcohol pads 10 times. or 10 sec. flush with 10cc of ns then draw back 10cc of bad blood then draw blood. then flush with 20cc of ns.

again every one this is talking about

pivc not picc. thanks!

Specializes in Oncology.
With a MD's order, I place these every time I'm on call. I do it independantly, or without any assistance in its placement. Yes, I think we can agree that a PICC is different than a short term peripheral IV which is changed every 48-72 hours. This short term catheter is what the original poster was referring too.

I know that some nurses do them, generally with extra training, that's why I said "generally." My comment about a PICC being different from what was being discussed refers to Snuggles49's comment that your hospital can order PICCs.

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