PICC line blood draw

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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?

KelRN215 said:
Take it out of the pyxis. When I worked in the hospital, this was a standard of care order that could be entered by nursing. I can count on one hand the number of times an MD ordered a 500 unit heparin lock flush prior to deaccessing a port-a-cath (precisely ZERO). This was something that had to be done and our 100 u/mL heparin was only stored in the pyxis. All you had to do was override and you could take it out. PICC lines that were not infusing IVF were to be flushed with heparin q 8hr- another standard of care thing. We did have 10 u/mL heparin flushes lying around though, along with saline flushes.

I'm sorry, I don't mean to be difficult, but I'm unsure how this would work out. Hep flushes have to be scanned on a COW and witnessed by another nurse.

I don't get PICC lines a lot because I'm in CPCU. That particular night that I drew blood from a PICC line they had floated me to ICU.

I suppose I would have to call the doctor each time for a PRN order? =/

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Specializes in Critical Care.
greyL said:
I'm sorry, I don't mean to be difficult, but I'm unsure how this would work out. Hep flushes have to be scanned on a COW and witnessed by another nurse.

I don't get PICC lines a lot because I'm in CPCU. That particular night that I drew blood from a PICC line they had floated me to ICU.

I suppose I would have to call the doctor each time for a PRN order? =/

Each facility should have a way getting these orders entered, but everywhere I have worked if it's a protocol to hep lock, then you write an order that says "Heparin IV 2ml... Protocol order for Dr. so and so/John Doe RN". Then it can be pulled from pyxis w/o override and scanned, ideally all of the protocol orders get entered when the PICC is placed as a PICC orderset.

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Specializes in Critical Care.
pknurse said:
This is the solid answer. Whatever the policies and procedures of the hospital are what must be done. You can actually receive disciplinary action for not following policy/procedures even if it aligns with evidence-based practice (e.g., aspirating on an IM injection).

Not to pick on you, but I hate the "follow your P&P" for questions that have only one truly correct answer. The physics involved in flushing and wasting blood in a PICC aren't altered by the facility a patient happens to be in. You should absolutely know your facility's P&P but not so you can just follow them blindly, know them so you know which ones are wrong and then get them changed.

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Facility specific with a basic underlying standard.

My work just changed ours.

Stop IV meds if running

Draw back first to check for air then flush with 10mLs, draw/waste 5mLs, draw 10mL for labs usually for basics. Change caps flush with 10-20mLs.

PICC lines require a female device for blood to tube transfer and Centrals can be accessed with male device for direct tube transfer where I work. Centrals are.a tad bit quicker because of that.

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greyL said:
So I looked up our policy, and it says we don't have to flush first. But now I'm in a predicament! Our policy says to flush with 20 mL NS after and if there are no IV fluids running, to also flush with 2mL hep flush.

I can't just get hep flushes whenever I want. We have to access them from pyxis and it is treated like a scheduled medication. What should I do about this?

If hep locking is your facility's policy for PICC lines, then the heparin flush should be part of the PICC order set and entered into the computer.

I know this is gonna sound harsh, but what's bothering me is, if you were not familiar with this procedure, why you didn't look up the P&P *prior* to performing it?

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Okay, I just thought of a more supportive way to communicate that last part of the above message, but the window of time for editing is past, so I'd just like to say that I'd like to encourage you that next time you need to do a procedure with which you are unfamiliar, to look up the P&P first. Sorry to sound harsh above. Sometimes I just need to think for a little while to find the right words.

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Specializes in L&D.

I flush with 10NS, draw out 10(waste) and then draw 10 for my labs.

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MunoRN said:
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.

Yep. The person that said 20 of waste? WHY????

~*Stargazer*~ said:
Oooh, good point. I have a system that I follow every blood draw that helps me to not do this. I place the waste syringe on the far right corner of the work surface away from me, and the draw syringe on the close edge of the work surface near me. Every. Single. Time.

I always pull my waste back into my flush syringe, which is prefilled so it's got the saline label on it. That way it's OBVIOUSLY not my sample syringe.

greyL said:
So I looked up our policy, and it says we don't have to flush first. But now I'm in a predicament! Our policy says to flush with 20 mL NS after and if there are no IV fluids running, to also flush with 2mL hep flush.

I can't just get hep flushes whenever I want. We have to access them from pyxis and it is treated like a scheduled medication. What should I do about this?

Ask a coworker how it's handled at your facility.

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Specializes in Med/surg, Tele, educator, FNP.

20 mls is a lot to waste I agree, but that's our policy. Also, we need an order to use the PICC line to draw blood, that is also in the policy.

Sent from my iPhone using allnurses.com

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Specializes in Med/surg, Tele, educator, FNP.

At our facility they rather not use the PICC line to draw blood.....

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At our facility they rather not use the PICC line to draw blood..... Sent from my iPhone using allnurses.com

Wait a minute...so someone who has a PICC would have to be poked anyways for a blood draw? Why?!

At my facility, we use PICCs quite a bit and we normally do not flush prior to blood draw, waste 6 ml, and flush with 10 ml of saline if line is in active use. Add in heparin flush if it's not which is in a pre-filled syringe (pharmacy supplies it to us, not in Pyxis). Caps changed every 4 days but also with blood cultures

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Not using PICCs for blood draws is very old-fashioned policy. Someone at that facility needs to be spreading the evidence-based practice love.

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