drawing blood from picc or port

gitterbug · Dec 16, 2006

If ER admit then ER attending can write order for blood draw from PICC or Portacath. Otherwise, calling a physician for order is correct protocol. Patients with PICC or Portacaths here refuse to be stuck for blood simply because they have these devices implanted for blood draws, why do your patients allow themselves to be stuck and usually without success?

veronica butterfly, ADN, RN · Dec 16, 2006

If ER admit then ER attending can write order for blood draw from PICC or Portacath. Otherwise, calling a physician for order is correct protocol. Patients with PICC or Portacaths here refuse to be stuck for blood simply because they have these devices implanted for blood draws, why do your patients allow themselves to be stuck and usually without success?

I agree, it is sooooo frustrating to me to get a patient for the first time after they've been in our facility for several days and see they have a picc/port and lab is still coming.... I'm new to this profession and don't want to come off as a 'know it all' to my experienced coworkers, but this just burns my britches. And I work mostly nights so at midnight, I get to decide whether to call the doc and request that I can draw blood in a few hours.... Where is the compassion, and isn't that why we hopefully got into this difficult and rewarding job? I don't understand why we need the order since, yes!, isn't this the point of a port?

Why do these folks allow us to continue to needlesslypoke them? Because they are sick, vulnerable, and trusting. Oh, don't get me going....:uhoh21:

That's an excellent point about ER getting the order, next time someone comes from ER, I will ask that at report, and also bring this up at our next staff meeting.

crb613, BSN, RN · Dec 17, 2006

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

RNsRWe, ASN, RN · Dec 18, 2006

We need an order to access an infusaport for the first time. No orders needed to draw from a PICC or port (once opened).

Daytonite, BSN, RN · Dec 24, 2006

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

Actually, no, there isn't. But, I believe that the major reason that many facilities do prohibit blood collection from PICCs or ports without an order or a facility policy is because PICCs, in particular, if not flushed properly after blood draws will get clotted up. Most facilities do not have many nurses on staff that are able to de-clott these central accesses unless they have IV teams or nurses in the intensive care units who are trained in de-clotting. It is far more inconvenient to have a line clotted up than to have the lab come up and stick the patient.

Because I worked on an IV team for years and was certified to insert PICCs and repair Hickman as well as triple lumen catheters, I would draw blood from all these lines. Of course, I knew my facility's policy. The trick is to pull the blood gently through the PICC since the lumen is small and then flush it liberally with 20 to 50cc of saline in order to clear all the blood from the lumen. Remember, a PICC line is often 30cm long from the insertion point in the arm to it's distal point in the vena cava. There's a lot of blood cells that can linger in that catheter and they need to be fully flushed out of the lumen of the PICC.

CarVsTree · Dec 25, 2006

We don't need an order for either. So, I draw from PICC's all the time. We did have a GN draw blood and forget to flush afterwords. PICC team had to come the next day and flush with TPA.

Regarding ports, you need to know how to access a port in order to draw. I work trauma and very rarely see ports, so when it comes up we call a nurse on onco to either show us or draw it or us.

veronica butterfly, ADN, RN · Dec 26, 2006

The trick is to pull the blood gently through the PICC since the lumen is small and then flush it liberally with 20 to 50cc of saline in order to clear all the blood from the lumen. Remember, a PICC line is often 30cm long from the insertion point in the arm to it's distal point in the vena cava. There's a lot of blood cells that can linger in that catheter and they need to be fully flushed out of the lumen of the PICC.

That's really interesting. Our protocol when drawing from picc/port is to finish by flushing with 10 cc saline. 10.... You're completely right that 10 cc is not enough to go the whole distance of a picc. Thanks, I'm bringing this up at work.

wmsclan · Dec 29, 2006

we don't need an order to draw from a picc. need a one time order to access a port and only rn's can do that. once the port is accessed both rn's and lvn's can draw blood/push meds etc.

1studentnurse · Feb 9, 2008

In my state, only licensed nursing personnel can draw from PICC lines or Portacaths.

In my facility, any new PICCs or Portacaths must be assessed and accessed initially by our IV therapy staff before we can do anything to them at all, period. This means if new guy needs his Vanc at 1800 and he arrives at 1759 it's late until IV therapy gives their blessing on his line (assessment, flush and dressing change). Floor nurses cannot initially access a Portacath, either. Only the IV therapy folks can at our place.

After IV therapy does their work, the floor nurses maintain the lines. We follow protocol to flush with saline before and after draws. If the patient needs heparin for them, we have to get an order to flush with heparin.

If it clots, it's a pain, because we need an order for Alteplase, once, of course, the IV people determine that it's really clotted. You'd be surprised how people think a line is clotted when it's not really. When in doubt, I always move the patient around as needed and use more saline, if possible.

barefootlady, ADN, RN · Feb 10, 2008

We do need an order for a blood draw from any implanted device or port or line to draw blood from that site. Only RN's or doctors may draw from these sites.

It is the patients responsibility to tell the doctors or nurses they have a port or site or line even when they are admitted . Sure it is our responsibility to do a complete assessment, but sometimes lab shows up to get specimens when we are doing our assessments, so we teach all of these patients to tell the staff immediately when they are admitted, that way we can get the order needed to draw blood and not have to patient stuck needlessly. If the patient is unable to speak then family needs to let the staff know there is a port or site. We do not seem to have many problems with this anymore, so our teaching has been and continues to be effective.

queenjean · Feb 20, 2008

I don't think the PICCs can hold that much fluid at any one time; why would the manufacturer recommend flushing with a certain amount if it wasn't enough?

Our facility does not need an order to draw from a picc or an accessed port. Only an RN can to the draw.