Drawing blood from PICC lines - page 3
I work on an Oncology unit where many pts have PICC lines. there are 3 drs that routinely start them for us. These drs say that we are not to use them to draw blood for labs. They have said that... Read More
Mar 8, '03Tory, I just want to approach your question from a different angle here. From some of your previous postings, it is obvious that your employer is very lax about training. My guess is that the docs are not wanting blood to be drawn from PICC lines on their patients because of a history of the lines becoming clotted or having ither problems after blood draws have been done by inadequately oriented/trained staff.
It should not be a problem to do blood draws and maintain the line. But when there is either no policy guideline in the facility or this information is not available and taught so that the procedure can be uniformly practiced by all the nurses on the unit, problems can and will result.
Mar 8, '03At my facility we are allowed to draw labs from PICC lines as long as they are a 3 fr or bigger. This is great for the pediatric population since it means that they don't need to experience another poke.
Mar 8, '03My facility has recently added prefilled saline syringes to our supplies in 5cc and 10cc sizes. I can't remember the company they are from. The interesting part is that the barrel of the 5 cc syringe is the same diameter of the standard 10cc syringe which means the pressure is supposed to be the same that would be exerted by the 10cc syringe. We do draw from PICC's routinely.
Mar 10, '03"look it up" check out the website for the PICC manufacturer, read their guidelines for use. compare it with your nursing policy and procedures. Make use of the websites that are reliable, the Intravenous Nurse Associations have a list of good websites. oh! be sure to note the last time your policies and procedures were up dated. check their references and how recent the references are. What You do is What you get.
Apr 21, '03this might sound dumb, but maybe you're not alllowed to draw because it would affect test results? I am thinking that in some cases, no matter how much waste is drawn, certain things (lipids for ex) would alter labs anyway. It seems like we poke kids for peak and troughs all the time, and they all have piccs or mediports.
Apr 21, '03We take bloods from PICCs using similar protocols as discussed as above. However we are told it depends what size the PICC is. Only able to use it for blood draws if it is greater thatn a size 3 french. If it is smaller than that we always have to have fluids running...which is a real pain for the patient being attached to fluids the whole of their hosp stay.
Apr 21, '03Originally posted by Tory
... Some RN's abide by this and have lab stick the patient for labs. Other RN's draw blood from the PICC reason being,....they don't have any veins to begin with (which is why they have the PICC). I would like to get your opinion on this. I am a fairly new grad and have made waves with this. I used to draw blood from them until I learned the drs said not to. So now I refuse to do it and have lab do it (often times they are unable to get enough blood or can't find a good vein). Just curious. Thanks!
Apr 21, '03Originally posted by Sleepyeyes
We are not allowed to draw from a PICC when the pt has a heparin gtt, for obvious reasons.
Why not? The reason isn't obvious to me! I would think you would not want to do a peripheral draw on a pt. receiving heparin, because they are much more likely to bleed from the puncture site and get a hematoma!
Of course, you would have to disconnect the drip to do the draw, flush pre and post, then reconnect. That would keep the heparin from contaminating the sample(s) drawn.
In the community we use heparin for 2 things 1) Hepalean is used to flush central lines (usually 10 cc NS, then 3 cc Hepalean) and 2) Fragmin (low molecular wt. heparin) is given to pts. with DVT's by s.c. injection. We don't do heparin drips, so maybe there's something I don't know here....
Apr 28, '03i've inserted a few picc lines and do use them to draw blood with 10 cc syringe; BUT the problem i've noticed is other nurses aren't heparinizing the lines after draws. this is important with small lumen caths. i've noticed younger nurses seem to think heparin flush solutions are dangerous. they are misimformed by misimformed teachers. SASH used to be the norm and was and is effective, but hospitals have switched to ns flushes only for the primary purpose of cost-savings. sure are alot of clooted lines these days?????
Apr 28, '03Jay Jay,
Some facilities prohibit coag draws from heparin lines - as the heparin coats the line and alters the results. Just as the same facilities bar drawing tac levels from tacrolimus lines or chems from TPN lines.
Apr 28, '03Contact Mfr of PICC for latest research, discuss with Cl mgr /administration and if policy can be updated to reflect current research FIGHT FOR PATIENTS BEST INTEREST.
Apr 28, '03As far as the Heparin problem - I am speaking from experience only.
I have had different nurses draw repeated PTTs from central accesses (that had heparin infusing via the line ) - stop infusion for 15 minutes - flush with 20-30 cc NS - waste 10 cc or more blood and submit specimens to result greater 150 - only to have a draw with a peripheral stick at same time and get a result WNL. Same problem with Tac.
The option, most facilities that I work with go for is double lumens (or triple with some accesses) - reserving one line "clean" with no Tac or heparin used in it.
Interesting thing Karen," X"Philly wants ALL labs drawn peripherally - and centrals reserved strictly for fluids - and that is THE OFFICIAL POLICY.
Apr 28, '03Having had my MIL develop coagulopathy 9 yrs post chemo and seeing her black and blue from fingertips to upper forearms, I'm more sensative to the rights of clients. Portacath relieved her suffering and everyhting was drawn from that.
What is patients DX, what do arms look like these are all things to take into consideration along with POLICY. Use your assessment skill to get variation on policy IF patient is suffering.
I've gotten VO from docs to override policy due to individual patient need.
Yes you do need to follow your facilities P+ P but does'n't mean that new research with improved PICC product might not be waranteed for policy review.
In most adult homecare IV companies I've covered (8 different ones) we drew all labs from PICC---only if erratic labs or smaller than 3 FR did we do peripheral stick---(with execption of Blood cultures).
All policies should be reviewed anyway at least q 1-2 yrs with literature search for best pratice done.