Drawing blood from PICC lines - page 4

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

  1. by   jblemire
    Quote from JNJ
    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??
  2. by   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> administeration, since CA pts will have a hardened wall veins so it's usually difficult to get blood from their veins>>>

    Have a look over this link for detailed information on this matter!

  3. by   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.
  4. by   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 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.
  5. by   BBFRN
    Quote from NurseKrissy
    We draw from PICCs all the time, you just can't use a syringe bigger than 3cc.
    You might want to check on that. It's standard protocol to use 10cc syringes for PICC draws and flushes.
  6. by   oldiebutgoodie
    At my hospital, we draw blood from PICCs all the time. However, the nurses who place the PICC (we have a special team who do it) post a notice over the patient's bed with instructions on blood draw, including,

    1. Use 10 CC syringe for flushing (don't remember if there was a recommendation for drawing)
    2. Flush with 20 CC after finishing with draw

  7. by   antsypantsy
    (preface: I'm applying to nursing schools because of my experiences as a patient)

    I have had maybe 6 different PICC lines in my arms over the course of 3 yrs, as well as a Hickman catheter. No one in all that time was ever brave enough to try it with me-- and I certainly wish they had!! My veins in my right arm (left was preferred for the PICCs) got harder and harder to find after getting blood drawn every week. This was about 19 yrs ago, frm when I was 15-18.

    Also want to say that you lovely PICC people are the reason I want to be a nurse-- you're all the best!! Seriously, I got muuuuuch better care from nurses than from doctors.

    ps I had Lyme Carditis. It was an interesting life experience, to say the least...
  8. by   SFCardiacRN
    A 3cc syringe creates more pressure than a 10cc. Hard to believe but true. I would be very careful when going against a Dr's orders. You better be sure you are unquestionably right.
  9. by   steelcityrn
    picc lines can be very fragile for lab specimens because alot has to do with narrowing of the line and the valves. I always try them first but if its running slow, its venipuncture time.
  10. by   nbnurse95
    At our hospital it's very rare for a dr to allow blood to be drawn from a PICC.
  11. by   Alexsys
    Quote from Jay-Jay

    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....
    This is how we do it at my facility as well. I would have a peripheral stick done in the case the coag check was not WNL from being drawn from the PICC. A picc line could last a while if it is maintained properly(i.e. flushing and flushing technique) and if the nurse drawing blood from the picc does not draw too fast--pulling too fast if the number 1 problem with hemolyzed blood draws.

    To the poster that has bigger fish to fry, I would think that advocating for your patient's well being would have been one of those fish. I would be a bit iffy on having my patient on heparin have their labs drawn peripherally. Especially if they have many timed study labs throughout the shift. to many risks with bleed out and hematoma development. But on the other hand sometimes the MDs would have good reason for their decisions though. But I would want to know.
  12. by   nightengale0
    Just wondering the rationale for flushing before blood draw on PICC. Our policy is waste 5cc, get specimen, then flush (20cc ns, 3cc heparin), no flush prior. Thanks!
  13. by   morte
    Quote from nightengale0
    Just wondering the rationale for flushing before blood draw on PICC. Our policy is waste 5cc, get specimen, then flush (20cc ns, 3cc heparin), no flush prior. Thanks!
    if you are in a no "heparin" institution, prob makes sense.....the pre flush would be to clear any residual drug from the cath...