How long do you hold IVF when drawing blood from PICC line?

RNsRWe, ASN, RN · Aug 17, 2008

At the hospital which I just started working, they hold fluids for 1 minute prior to drawing blood from PICC? I was wondering if this was long enough?
Also, when you guys listen to lung sounds do you only check anteriorly. I was taught to check posteriorly but my preceptor only checks anteriorly. How can you tell what the lung sounds are at the bases?
I am not knocking my preceptor just wondering what the majority do. Thanks!!

We don't "hold" the fluids, but just turn them off, flush well, then draw up a waste (10cc) and then draw the tubes needed. We never get screwy labs from doing that.

Lung sounds should be posterior, all fields, anterior, all fields. Anything less is not a full assessment. Personally, I think ALL lungs are "diminished in the bases"!

correctlywrong · Aug 17, 2008

With a picc, the tip of the catheter is in such a large, turbulent vein that anything that was infusing is typically swept away within seconds. Waiting a minute is generally more than enough time. Flush, waste 10cc, and draw labs. And then flush with at least 10, preferably 20cc of saline, with a pulsing, stop and start approach so that you thoroughly clean the line before you replace the fluids. The steady flow of the running fluids is not as effective at flushing the line as a turbulent, stop and start flush.

As for lung sounds... many of my patients couldn't sit up if they wanted, and I don't feel that hearing the posterior bases is important enough in a stable patient to justify making them have to flip all around. Then again, I am in a desperately short-staffed acute care setting, and I just can't spare the time to do everything the way I learned in school. It is a shame, but cutting those kinds of corners on the stable people allows me enough time to provide adequate care to the others.

Burnt Out, ASN, RN · Aug 17, 2008

I just normally turn the fluids off, draw my waste, draw my labs, flush and start the IVFs back again. Now TPN or PPN, I turn off for several minutes first, then do the same as above.

I listen to all lung fields. If a patient isn't well enough to sit up, I ask them to roll briefly or get someone to help me roll the patient.

BelleKat, BSN, RN · Aug 17, 2008

For PICC labs I just turn off IVF and flush,withdraw discard and draw labs.

I always listen to Ant and post lung fields at least once on my shift,usually in the beginning. The ones who can't roll or are sicker are the ones that usually need the better assessment. The pts with no status change I just do a brief assessment to follow up later in the shift,the onces with obvious problems,on O2,bedrest,etc I always try to keep up with their post BS too. That's often where you hear the signs of fluid overload first such a rales(crackles) and rhonchi.

uscstu4lfe · Aug 17, 2008

Do you have to have an order to draw from a PICC line? It's been so long that I have forgotten.

I had 2 preceptors during my orientation - both of them didn't even bother to listen to lung sounds, unless the patient was admitted for something respiratory. And somehow, through the grace of God, they always charted that the lung sounds were clear. Amazing!

TeresaB930, BSN, RN · Aug 17, 2008

I was taught if you don't listen to lungs posteriorly, you haven't listened to the lungs.

I was fortunate enough to spend 2 weeks with an awesome respiratory therapist. She taught me this.....when a patient is laying supine, ask them to take their right arm and cross it over across their chest. This gains you access to the right lung and visa versa for the left.

Beaches10 · Aug 18, 2008

Yep, agree with Theresa. All it takes is a shift in position of the arm to hear the base of lung air exchange and if there is a problem. Find on my AM shift that the patient is generally in their most comfortable position, many having not moved spontaneously all night and discover that I have to be the "bad" nurse once again with the move, move, move routine and yes incentive spirometry doesn't work unless you use it every hour or two. More acute, unresponsive patients you find the pool of fluid in lower positioned lung and flanks-a key to fluid overload or third spacing, not always preventable/curable in the end of life stage and renal patients.

GrumpyRN63, ADN, RN · Aug 18, 2008

I hold my fluids ,thru all lines for 2 minutes, listen to lungs ant and posteriorly, missing most of your lung fields if you just listen anteriorly ......

Penelope_Pitstop, BSN, RN · Aug 18, 2008

is it necessary to waste 10 ml? when i worked medsurg, we wasted 5 ml. it was the protocol, but now i wonder if that would mess with anything?

*jess*

iluvivt, BSN, RN · Aug 18, 2008

One minute is adequate along with an appropriate discard to ensure you will get a clean and good specimen. If you are drawing from a multilumen lines,any lumen with infusions must be stopped as well. This may pose problems with certain drips like the vasopressors,and in that case another option for the draw must be selected. Personally,I can hear the lung sounds better from the posterior assessment especially in the bases and especially in women with large breasts.

RNsRWe, ASN, RN · Aug 18, 2008

Do you have to have an order to draw from a PICC line? It's been so long that I have forgotten.
I had 2 preceptors during my orientation - both of them didn't even bother to listen to lung sounds, unless the patient was admitted for something respiratory. And somehow, through the grace of God, they always charted that the lung sounds were clear. Amazing!

No, no order needed. Most MDs will assume that you ARE drawing from the PICC if the patient indeed has one. We only don't draw from the PICC if the MD prefers not to for some specific reason, and that's quite rare.

As for the lung assessment guesswork, well....that's fraudulent charting, and poor nursing assessments. Preceptors, huh?