PICC line blood draw

[greyL]

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?

[Asystole RN]

LadyFree28 said:

It is protocol at my facility to waste with 3 mL syringes.

NONE

^THIS.

Any more questions? ?

Is the protocol to waste 3mL of blood or to use a 3mL BORE syringe to waste 3 mL of blood? Big difference.

[wooh, BSN, RN]

I know 10 ml syringe used to be minimum that could be used (and is what is still policy at my workplace to use) but is that still the standard? I would think over the past decade that the materials used to make CVLs might have advanced to where smaller can be used. Even if for "normal" PICCs the minimum 10ml syringe is required, are they required for CT contrast capable ones?

[Asystole RN]

wooh said:

I know 10 ml syringe used to be minimum that could be used (and is what is still policy at my workplace to use) but is that still the standard? I would think over the past decade that the materials used to make CVLs might have advanced to where smaller can be used. Even if for "normal" PICCs the minimum 10ml syringe is required, are they required for CT contrast capable ones?

10mL bore syringes is still the standard. There is little information on actual drawing bore size, I'll have to look up the AABB standards. I know that vaccutainers are contraindicated for use with PICCs due to excessive negative pressure so I assume there is something on smaller bore sizes in drawing. I pasted what the INS says on flushing and the Bard Power PICC IFU states in all caps, "DO NOT USE A SYRINGE SMALLER THAN 10ml."

Quote

2011 INS Standards of Practice; Standard 45. Flushing and Locking;

H. To prevent catheter damage, the size of the syringe used for flushing and locking should be in accordance with the catheter manufacturer’s directions for use. Patency is assessed with a minimum 10-mL syringe filled with preservative-free 0.9% sodium chloride (USP).

[MunoRN, RN]

Asystole RN said:

10mL bore syringes is still the standard. There is little information on actual drawing bore size, I'll have to look up the AABB standards. I know that vaccutainers are contraindicated for use with PICCs due to excessive negative pressure so I assume there is something on smaller bore sizes in drawing. I pasted what the INS says on flushing and the Bard Power PICC IFU states in all caps, "DO NOT USE A SYRINGE SMALLER THAN 10ml."

"2011 INS Standards of Practice; Standard 45. Flushing and Locking;

H. To prevent catheter damage, the size of the syringe used for flushing and locking should be in accordance with the catheter manufacturer's directions for use. Patency is assessed with a minimum 10-mL syringe filled with preservative-free 0.9% sodium chloride (USP)."

Assessing patency with a 10ml syringe is still the standard, once patency is confirmed, bore size makes little difference.

If vacutainers are contraindicated on PICC's that's news to me. Our POWER PICC IFU contains directions on how to use a vacutainer with a PICC, and the "experts" on another site have discussed this and there was no mention of any recommendation not to use a vacutainer on a PICC due to potential damage to the PICC.

[MendedHeart]

We are not allowed to use vacutainers on our PICCs.

Also,We have to use 10ml syringes for PICCs and CVCs. I have seen the 3mL syringes used at other hospital but they were the same bore as the 10ml which makes it the same pressure which is the issue with the smaller syringes.

[LadyFree28, BSN, LPN, RN]

\ said:

We are not allowed to use vacutainers on our PICCs. AlsoWe have to use 10ml syringes for PICCs and CVCs. I have seen the 3mL syringes used at other hospital but they were the same bore as the 10ml which makes it the same pressure which is the issue with the smaller syringes.

^I worked at a facility where the 3 mL and 10 mL syringes have the same bores as well.

FYI, I am one who scrubs the hub and practice meticulous care for the 15 secs; I am sure there are many nurses...I'll say MOST nurses who do uphold strict standard of care

I think one has to be VERY prudent when dealing with central lines; I think one should be mindful to think better of our peers in are maintenance of PICC lines.

[LadyFree28, BSN, LPN, RN]

Quote

Is the protocol to waste 3mL of blood or to use a 3mL BORE syringe to waste 3 mL of blood? Big difference.

See my response above, as well as in my original post; what I wrote was the protocol.

I work at a facility where EBP is the upmost standard of care...so if you have an issue with their standard of care, and their adherence to INS protocol (which is a part of their standard of care) feel free to contact them; they are one of the top 10 facilities in the country. ?

[brithoover]

We waste 3 ml, draw needed amount of sample then flush until blood is gone from the cap

[Twisted Nurse]

Always go by your hospitals policy guidelines. There should be guidelines regarding blood draws from central lines.

In my hospital, you:

1. Stop any infusion for 1-2 min

2. Flush 10cc saline

3. Remove 5cc for regular labs, 10cc for coags

4. Flush 10cc saline

5. Change hub if blood is present d/t increased risk of infxn. If collecting flood cultures, you change hub prior to drawing blood.

1) Pulsatile flush w/ 10 ccs

2) Wait 15-20 seconds (several heartbeats)

3) Slowly withdraw 3 ccs of blood (approx 5 cc total including NS in line)

4) Draw your sample

5) Pulsatile flush w/ 10 ccs

Blood is a precious resource... don't waste it.

[brithoover]

Can someone explain the reasoning of flushing with 10cc before your discard?

[MunoRN, RN]

Are we under the impression that a 10ml syringe limits the amount of pressure in the lumen?