Help with picc blood draw

[melissahunter2]

I have drawn many labs from picc lines when I was working in the hospital. Most of them were the power picc lines. I have a home health patient that has a picc line that has no clamps on it and the end caps are horizontal, unlike the power piccs. It flushes easily but does not have any blood return. There are orders for a lab draw. HELP.

[APRN., DNP, RN, APRN, NP]

the "t" shaped caps sound familiar to me. if i recall, the hub portion is a blue color, and the port portion (where the syringe inserts) is white and is flush with the housing. they are positive pressure caps.

in the last three facilities where i have worked, the picc team instructed us not to use the clamps on the picc lines. when you clamp the line routinely, the clamp intereferes with the positive pressure valve function of the positive pressure caps. this allows blood to suck back up into the line and cause a clot, which results in an inability to get a blood return.

in my facility, we just tpa the line and let the altaplase dwell for a good 2 to 4 hours. this usually does the trick, and the line is good for blood draws again.

hope this helps.

[Dirkje45]

i don't think hh nurses can use tpa in the home? perhaps they can but i'm not familar with that practice, patients usually come into the er to have their picc's cleared.

[APRN., DNP, RN, APRN, NP]

I haven't worked home health in about 10 years, but in my facility, we TPA the line.

As a rule, home health nurses are pretty darn resourceful. Maybe she'll be able to get a peripheral stick.

[annaedRN, RN]

Do not know about all states, but in Pennsylvania we can do tPa in the home.

[iluvivt, BSN, RN]

If neither lumen will draw blood can will instill easily you have what is called a persistent withdrawal occlusion (PWO). If the PICC line will be used for a significant amount of time ( more that 48 hours more) the lumens should both be treated with 2 mg each of Cath-flo (Tpa). In California we can do this home care and I cannot image why any state would restrict its use in home care since it is the recommended treatment for thses situations.

The kind of cap the previus poster was describing is called a a CL-2000 by ICU medical and it is a positive displacement cap. If your PICC is clampless you would just flush,still using a pulsatile flush and then just disconnect as the cap upon disconnection displaces the fluid and eliminates or reduces reflux of blood into the distal end of the catheter ( minimizing occlusion ans as a secondary benefit infection)