Drawing Blood From PICC Lines

[rileygrl11]

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 this will cause the line to collapse. At my hospital, the RN has to do lab draws from central lines/PICCS. 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!

[caroladybelle, BSN, RN]

Jay 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.

[caroladybelle, BSN, RN]

Jay 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.

[NRSKarenRN, BSN, RN]

Contact 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.

[NRSKarenRN, BSN, RN]

Contact 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.

[caroladybelle, BSN, RN]

As 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.

[caroladybelle, BSN, RN]

As 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.

[NRSKarenRN, BSN, RN]

Having 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.

[NRSKarenRN, BSN, RN]

Having 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.

[jblemire]

JNJ said:

Any chance there is confusion over PIC (peripherally inserted line) and PICC (peripherally inserted central line). Otherwise mjlrn makes sound statements. However, if the docs. and protocol are not sensible, it's up to the RNs to work up a presentation for change.

I recently accessed CDC guidelines for PICCs and they were surprisingly unspecific (related mainly to infection control issues.) So back to the manufacturer of the line most commonly put in in your unit. Can the rep. help you here? The flushes/waste blood amount mentioned in above posts sound huge to me. The volume in these lines (in pediatrics) is really small, around 0.3 ml per manufacturer.

Absolutely agree with nothing less than a 10cc syringe. Both pushing in and pulling out, smaller syringes create more pressure. I've demo'd this to students with a removed line.

I now work with an 18 month old PICC line with two ports which is maintained on a 30 lb child with obsessive attention to technique. We draw blood x 2 weekly, small pre and post flush of saline. Patency is maintained with q24h with 3 cc heparin. Valve change q3 days. 10 cc syringes. I cannot imagine managing her care without a PICC.

Incidentally, anyone out there with a line older than 18 months? What's the record on this?

If you are accessing the picc line several times during the day for antibiotics, how often do you flush with hepelean??

[Nayoby]

I always withdraw blood from PICC, as far as I Know it's made for that especially in oncology cases when it would be difficult to find good veins due to chemo> administration, since CA pts will have a hardened wall veins so it's usually difficult to get blood from their veins>>>

[Nurse Cozmo]

In our hospital, and I also work an oncology unit, we RN's draw from all central lines. With picc's we waste 3ml's, use the vacuum ports for the tube draws, and then flush with 20 mls.

[labman]

wow we have much different posts about this topic. Here are my personal opinion about drawing blood from a pic. Personally I can see both ways. It is so tough to get blood from someone from oncology and I always feel terrible:o poking them because I feel they are already going through enough. I guess if the MD doesn't want you to draw off of them it is not a good idea they probibly have a good rationale (get clotted or infected). With drawing it with heparin our policy states that if you flush with 10cc then waste 10 cc it is ok. I still am very lerious about that. I will believe it when we get some research done on it. Otherwise I think if they have a good centeral access they should avoid a stick and get blood drawn from the picc.