Nurses not flushing out P.I.C.C. lines - page 3
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Aug 20, '06Quote from Trauma_Team_1After the first post in this thread deeming nurses lazy for not flushing PICCs, i'm not buying that.Not on my part...ask the lab staff......
Originally Posted by Trauma_Team_1
We have our tricks also, such as if there is a floor that is treating the lab staff particularly bad we just take more time to get up on the floor
Always remember, respect goes both ways. Don't slam a group of people (or immaturely take forever to get to a floor, jeez), and then wonder why that group doesn't respect you.
Aug 20, '06Quote from TweetyI'm doubting the bad place is one-sided though.To this OP please note that lab and nurses usually get along pretty well in other places. You're place of work sounds disfunctional, so no need for you to generalize that nurses and lab doesn't get along, because it's not true.
Yeah sometimes there's a scuffle when we need something stat, or somethings been missed, or misplaced. But usually it's a very cordial professional relationship we enjoy.
Also note that for the most part......in other facilities.........nurses do flush their PICC lines.
You just work in a bad place.
Good luck in school.
Aug 20, '06Just piping up to say that the nurses where I work get along fine with the lab, too. We draw our own blood (ICU) but I'm sure we'd get along fine with phlebotomy, too if they were around. Unless we knew that they were purposefully putting our patients lower down on their list because of something petty -- our patients are really sick and this is no time for egos. If a nurse was being unreasonable, you need to calmy let him/her know that you are unable to accomodate them -- but don't punish the patient.
But really, there is no "us vs. them" with any of the departments in our hospital. And we don't argue about who works the hardest because we're all too busy...you know...working.
And I flush my picc lines per protocol, thankyouverymuch.
Aug 20, '06clogged PICC lines, get an order from the MD to put activase in to clear it, i work in home health and we have to do this at home all the time. what we find is the local hospitals only use saline to flush the lines and at home we use saline and heparin unless it is a groshung.
Aug 20, '06Quote from MarySunshineDitto...had 4 pts on telemetry with PICC lines last week and flushed them as ordered.And I flush my picc lines per protocol, thankyouverymuch.
Aug 20, '06Everyone. . .PICC lines are not the same as other central lines. They often have smaller lumens; they are designed for longer term medication delivery. They are not, in general, designed for blood sampling although it can be accomplished as long as they are liberally flushed following the withdrawing of blood. This is in direct contrast to the usual procedure for withdrawing blood from other types of central lines. Additionally, because of their length they tend to develop whopping amounts of fibrin around them which requires the same de-clotting procedures if they interfere with infusions. When attempting to withdraw blood from a PICC, which is in the totally opposite direction from the way fluids were designed to go into them, a number of things can happen to prevent the blood from coming back, such as a fibrin flap occluding the catheter tip OR the catheter collapsing upon itself from the negative pressure applied to it by the syringe in trying to withdraw the blood (these catheters are very delicate and not designed for this, particularly the Bard groshongs). Acute hospital care nurses who do not routinely work with PICC lines, especially ones in people coming from home would not always be aware of this. PICC lines are also subject to a phenomenon known as "pinch off" which is akin to obstuction by positioning of the limb. PICC line maintenance has become a very specialized nursing procedure. The nurses dealing with PICC are mostly your home health nurses, chemotherapy nurses, IV therapists and nurses certified to insert them.Last edit by VivaLasViejas on Aug 20, '06
Aug 20, '06My experience has been that nurses don't have some sort of universal problem with ancillary departments. As a phlebotomist I was treated wonderfully by nurses throughout the small hospital where I worked. ICU nurses let me watch the collections I couldn't do, and explained why, and how the arterial lines and stopcocks worked. Nursery nurses showed me better ways to get my PKU's done. ER nurses let me watch procedures that I haven't seen before or since.
I hope I'm passing such good behavior along to the lab where I work. We have had a fella lately whose central lines keep occluding. I can't find any obvious abnormality in his lab work, and I do find that the port that clotted was the one with the D5 running through it. So I began flushing that one more often with the push/pause and a heparin flush, then another NS push/pause, then hooking the fluids back up. 23cc of extra fluid is worth it twice a shift to keep the line open, in my opinion. And I still couldn't get a blood draw off of it, even with head and arm position changes. Sometimes we do our job and things just don't work.
To the OP: relax, smile and say "hi" to people while doing your job. Ask questions. You'll find nurses are people too. When you get to be a nurse, you will see your behavior in a different light.
Aug 20, '06Quote from Sylvit's also known as turbulent flow. instead of flushing it continuously with one steady motion, you flush 1-2ccs, pause, flush again, pause, flush again, etc.So what exactly is this push/pause method?
Aug 20, '06Daytonite - very educational post. When I worked at the hospital, we did not use PIC lines for blood draws, for the reasons you list.
I can't ever remember having problems with any of the phlebs - they were generally great at getting 'blood out of a turnip'. If we had a stat draw, and the phleb was busy, we either drew it ourselves, or someone else from the lab came up.
I had a PIC line a couple of years ago - I had osteomyelitis in my foot - and they did one for antibiotics. It was put in in radiology and was inserted in my upper arm - that avoided a lot of the 'positioning' problems.Last edit by banditrn on Aug 20, '06
Aug 20, '06Sylv wrote:
So what exactly is this push/pause method?
Also called "positive pressure technique" Basically "start/stop" or intermittent injection with 10 ml syringe of saline for maintenance flushing of the PICC line.
1. Use 10 ml syringe or larger. Rationale: Syringes smaller than 10 ml can cause too much resistance and may rupture the PICC line.
2. Push a portion of saline (2-3 ml), pause, then push, repeat until empty. Rationale: push/pause produces turbulence which may prevent formation of clots on the catheter wall.
Aug 20, '06I agree that sometimes you can't use PICCs for blood draws because of what might be running through it at the time. Like someone said earlier, if the patient is on a heparin drip and is having coags drawn, then the PICC is off-limits because it'd skew the lab results. Same with things like blood sugars - often they're inaccurate if there is dextrose running through the line. Another is medications levels - if that med has been infused through that line, there is a chance that the level drawn will be falsely high.
One thing that no one has mentioned is that there are some infusions through PICCs that should not be interrupted or flushed - thing like vasopressors or insulin drips. I don't know if it's just the NICU or not because 99% of the time we only have single lumen lines - but if we have a baby on those kinds of drips, we cannot flush the line because it would cause a bolus of the med.
Whole point being, it's best to ask why the PICC isn't being used for lab draws before assuming anything.