drawing blood from picc or port

[veronica butterfly]

At your facilities, do you always need a doctor's order to be able to draw blood from picc lines or portacaths? We do at mine, and often when someone is admitted to the hospital, that order is overlooked. This poor pt who has a picc or a port then ends up being needlessly poked/drawn until someone figures out and/or takes the time to call the doc and get an order.

Is there a reason why you wouldn't be able to automatically collect blood from a picc or port?

thanks!

[evilterry]

Do you take the cap off and draw from line directly? or do you draw with a syringe? or does your lab have supplies?

[veronica butterfly, ADN, RN]

Yes we take the cap off and draw out blood with a luer lock syringe that fits perfectly on the picc hub.

[iluvivt, BSN, RN]

Simply,write it in your nursing protocols and you will be covered. It is a perfectly acceptable practice with only a very few exceptions. You would not want to draw from a dedicated TPN line or interrupt certain drips or chemotherapy or if clinical situation dictates otherwise.. By the way even though PICCs are longer than other non-tunneled CVCs they actually have low priming volumes of .5 to 1.5 ml depending on gauge,type and length. Remember that most are now placed by Ultrasound and we do trim the open-ended one and use the shorter ones when using the Ultrasound. The rule of thumb to adequately flush any CVC and this includes PICCs is 2-2 1/2 x the priming volume,so you can see 5-10 ml of NS is plenty. We ask the nurses to use 20 ml NS after blood draws using a pulsatile push pause method. A 50 ml NS flush is overkill for every PICC on the market. The key is to flush immediately after the draw using a turbulent pulsatile flush with a 10 ml syringe. The priming volumes of most ports is 2-2.5 ml,so again 10-20 ml is sufficient. These are the INS recommendations as well.

[nrsang97, BSN, RN]

We don't need an order but an RN is the only one that can draw the blood.

Same here. Most of our patients have lines since I am in the ICU so we just automatically draw off them. Why put the line in and then continue to have lab poke them for blood? Seems silly to need a order to me. We don't have lab techs that come to draw blood. That is a nursing responsibility for us ICU and floor. So maybe that is why we don't need a order.

[MoopleRN]

We need an order for PICCs, not PACs. Most of our PICC placement orders will include an order to draw, if they don't, we're not calling the doctor at 0500 to get an order to draw for lab. They're not happy about that but I just remind them I need an order to draw and if I don't have one, they will have to poke. And we NEVER draw for an INR, even if they have an order.

Our protocol is flush, waste 5, draw your blood, flush with 10 NS and 3 heparin then put on a new cap. We recently had an inservice and we learned that drawing from PICCs should be a LAST option as it increases the chances of infection every time we access that port and it can contribute to clotting. Our policy is being rewritten in view of that but it'll be a long time in coming.