PICC line blood draw

OCRN3 · Nov 17, 2013

1.flush w/ 10ml NS

2. Withdraw 20 ml and waste

3. The 3rd syringe should be used

4. Flush w/ 10 mls NS

5. Change the caps

That's how I learned it...

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greyL · Nov 17, 2013

I feel like an idiot, but what caps? I've never heard of anything like that.

And I remember learning to waste 6, so I thought 10 would be plenty =/

cardiacfreak, ADN · Nov 17, 2013

OCRN3 said:
1.flush w/ 10ml NS
2. Withdraw 20 ml and waste
3. The 3rd syringe should be used
4. Flush w/ 10 mls NS
5. Change the caps
That's how I learned it...
Sent from my iPhone using allnurses.com

Our policy is to flush with 10mL, waste 10mL, draw blood, flush with 10mL, and we don't change the caps.

Love your avatar by the way.

The cap is the lock on the end of the line.

greyL · Nov 17, 2013

cardiacfreak said:
The cap is the lock on the end of the line.

Hmmm ... I think that maybe we don't have those.

boogalina, ADN, ASN, BSN, MSN, LPN · Nov 17, 2013

Flush w/10 mL NS.

Draw and waste 10 mL NS.

Draw blood needed for labs.

Flush with 20 mL of NS.

At my facility, caps are only changed if they were removed for drawing blood cultures.

DoeRN · Nov 17, 2013

Quote
Hmmm ... I think that maybe we don't have those.

Surely you do. It's the connector at the end where you put the syringe. I could be wrong but I've worked at 14 different hospitals as a traveler and every single one had caps on PICC lines.

I just follow the policy of the hospital I'm at. I've always flushed with 10, wasted 10, pulled back the blood or used a transfer device on the end. Flush with 10 and put a new cap with a flush and flushed with 10.

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Mommy&RN, BSN, RN · Nov 17, 2013

\ said:
Flush w/10 mL NS. Draw and waste 10 mL NS. Draw blood needed for labs. Flush with 20 mL of NS. At my facility caps are only changed if they were removed for drawing blood cultures.

This is how we draw also

Anna Flaxis, BSN, RN · Nov 17, 2013

greyL said:
What's the proper way to draw blood from a picc line? The other day I flushed with 10 cc's of NS, then wasted 10, then drew blood. But the lab called to say that the results looked wrong (extremely low hemoglobin level) and that the blood probably had saline in it. Another nurse told me that I'm supposed to waste more than I flush and that I did it wrong. Is that correct?

What is your facility's written policy?

It is not necessary to flush prior to drawing blood (unless your facility's policy says otherwise).

4-5mL waste is sufficient (again, unless your facility's policy says otherwise; also, you can actually see where the fluid in the syringe changes from diluted blood from the lumen of the catheter to whole blood from the venous system).

Follow the draw with a 10mL NSS flush (some policies state 20mL for open ended catheters).

Did you do a redraw to confirm the results of the previous draw?

On caps, the INS states:

Quote
Needleless connectors are changed if there is blood or debris visible within the needleless connector, upon contamination, prior to drawing a blood culture through a catheter, and routinely as established by the organization.

Asystole RN · Nov 17, 2013

greyL said:
What's the proper way to draw blood from a picc line? The other day I flushed with 10 cc's of NS, then wasted 10, then drew blood. But the lab called to say that the results looked wrong (extremely low hemoglobin level) and that the blood probably had saline in it. Another nurse told me that I'm supposed to waste more than I flush and that I did it wrong. Is that correct?

Are you sure that you used the syringe with pure blood instead of accidentally grabbing the waste and filling the tubes? It is not uncommon to accidentally grab the waste on the table, especially when both the waste and draw are 10mL. Having seen this done multiple times, and nearly done it myself, I am willing to bet this is how you obtained such a large amount of saline within the sample to significantly contaminate the test.

Consult your facility's P&P on drawing blood, if there is not a specific method described then the blood bank may give recommendations or your vascular access team. Minimally, twice the internal volume of the catheter should be flushed and wasted. For most PICCs this is somewhere around 1-2mL depending upon the size and length of the catheter.

Proper flushing and proper drawing technique is important. The "Pump&Pause" method is considered to be the gold standard. Instead of flushing or drawing in one single movement of the hand you flush or draw in 1-2mL increments, pause, and continue. The turbulence created within the lumen of the PICC helps to ensure a more homogenous movement of fluid.

If your needless access devices (the end cap/Luer lock) is not clear, so as to be visually inspected for residue, you should be changing those with each blood draw.

Asystole RN, CRNI, VA-BC

MunoRN, RN · Nov 17, 2013

I'm disturbed how common wasting 10ml is. Keep in mind blood draws and wastes are the main cause of iatrogenic anemia, which is largest cause of blood loss in hospitalized patients.

2-3 times the lumen volume is sufficient, additional waste provides no additional benefit. A power lumen on a PICC has the largest volume and is 1.7 ml. Non-power lumens are less than 1 ml.

Gabby-RN · Nov 17, 2013

It is good practice to change the caps on the picc anytime you draw blood or administer blood as well as with every dressing change. I am sure your facility has a policy for drawing blood from a picc. I like to refer to the policy for questions like that because every facility is different and sometimes we just do it the way we know vs the way the hospital wants.