Drawing blood from PICC lines

  1. 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!
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    About rileygrl11

    Joined: Feb '03; Posts: 126; Likes: 3


  3. by   WalMart_ADN
    we use PICCS on our heme/onc kiddo's all the time....why stick them when they have perfectly good central access? just make sure you flush them really well, with at least 10cc's (this is for kids, may be different for adults)and they shouldn't cause you any problems...
  4. by   VivaLasViejas
    You should not be drawing blood through PICC lines if the doctor ordering the labs says not to. This is something that needs to be brought to the attention of the people who make policy at your facility; it's up to them to determine whether or not this is OK. However, it sounds like the MDs need some education on this issue, because blood can easily be drawn this way as long as you are careful. I've always done it by withdrawing the blood a little at a time, both to avoid hemolyzing the sample and to prevent damage to the catheter, and then flushing the line per manufacturer's instructions. Never had a problem yet, except of course when the line was no longer patent for some other reason.
  5. by   Jay-Jay
    I have often done blood draws on PICC lines in the community. You have to know what type of line it is, however. Some have special one-way valves that can be damaged by pulling back on a syringe. Read up on it, educate yourself, then, if necessary, educate the doctors. Why should we stick a patient with poor venous access if they have a PICC or central line (Hickman, etc.) in place??
  6. by   Rohb
    WE draw bloods on PICC,just like everyone say here,follow your facility protocol.It's ashame to stick someone if you already got access through a PICC.Talk to yuor charge nurse.
  7. by   Sleepyeyes
    Our guidelines state that we can draw from a PICC but only from lumens equal to or larger than 0.5 French. So maybe the size of the lumens have something to do with it?

    Midlines cannot be drawn from; the catheter is too soft and will collapse.

    We are not allowed to draw from a PICC when the pt has a heparin gtt, for obvious reasons.
  8. by   RNConnieF
    We draw from the PICC. Our PICC protocol calls for referral for a PICC line for "poor venous access", meaning no peripheral veins for blood draws.
  9. by   NurseKrissy
    We draw from PICCs all the time, you just can't use a syringe bigger than 3cc.
  10. by   nightingale
    Could we talk about what the protocol says? I remember ours as Flush and draw using a 10 cc (using a smaller syringe creates too much pressure)>

    Flush with 10cc NS

    Draw 7CC - waste

    Draw needed amount of blood for lab test

    Flush with another 10cc (Creating turbulence)

    Then rehook to running IV or flush with 3cc Heparin (with a 10cc syringe)

    ---- Check your protocol.... but using 3cc syringe is a BIG no no...

    Great topic to discuss...
  11. by   MiddleT
    Syringe size makes a difference. We use only 10cc. Pressure does make a difference.
  12. by   caroladybelle
    I draw labs (other than PTT for heparin drip) from PICC frequently but have noted that some of the newer ones seem 'flimsier' than others. As far as I am aware, 10cc syringes are the standard for flushing/drawing for use with most VADs d/t pressure concerns, but have seen some Groshong PICCs crack no matter how carefully flushed.

    My question would be to the powers that be, "Why are we placing PICCs in patients with poor vascular access, when we can't draw blood from them, by policy" - If they are insistant on not drawing blood from PICCs - there are plenty of other devices to use that can permit blood draws (as well as being less limiting of venipuncture - can't use the PICC arm).
  13. by   Sleepyeyes
    Originally posted by MiddleT
    Syringe size makes a difference. We use only 10cc. Pressure does make a difference.

    We've been taught that as well.
  14. by   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?