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?

Specializes in Critical Care.
mmc51264 said:
We are being told not to draw from PICCs If we have to, flush 10, waste 20, draw 10, flush 10, hep lock 5.

They are trying to avoid infections.

Also depends on whether they are single lumen or dbl lumen power ports (the power ports are better).

Why on earth would you waste 20 cc of the patient's blood?

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It all depends on what your policy is on the issue. Each place is slightly different. But yes flushing with 10, drawing and wasting 10, drawing what you need then flushing with 10 is the usual that I have seen. Be sure that you use a different syringe to draw the sample with instead of the saline flush syringe, that may help clear things up.

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Specializes in Vascular Access.
MunoRN said:
Why on earth would you waste 20 cc of the patient's blood?

Muno,

Have you read the study where the researchers found that if one was drawing coags from a heparinized catheter becuase you did not have the ability to draw via peripheral vein, that in order to get accurate results, one must waste 25cc of blood?

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Specializes in Critical Care.
IVRUS said:
Muno,

Have you read the study where the researchers found that if one was drawing coags from a heparinized catheter becuase you did not have the ability to draw via peripheral vein, that in order to get accurate results, one must waste 25cc of blood?

The INS recommendation for general blood draws from a PICC or CL is to waste 1.5 to 2x the lumen volume, or about 3ml for a typical power lumen. Bard's recommendation is higher at 5ml.

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Specializes in Vascular Access.

I totally get that, and I am well versed in what INS states, but I was throwing out the possibility of one reason why this amount of waste might be put into practice.

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Specializes in Inpatient Oncology/Public Health.

Haven't there been studies too showing you can actually cause a drop in H/H in certain populations just with lab draw wastes? I know our Onc patients are riding the lines of needing transfusions most days anyway.

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This is an old post so I may not get anything, but can't hurt. My question is transferring blood from the syringe into the vials (my facility doesn't indicate use of vacutainers straight from the port). I've tried connecting a vacutainer to the syringe using a large needle but it ended up being messy and doesn't seem right. I've read of nurses pulling the top off of the vial and squirting the blood into vial fromthe syringe then recapping, but can't find any literature to support this (or rule it out). In fact while there is tons out there on the actual draw there is very little on getting the blood into the vials once you've done the draw. Any advice?

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Specializes in Trauma, Orthopedics.
jenngrove said:
This is an old post so I may not get anything, but can't hurt. My question is transferring blood from the syringe into the vials (my facility doesn't indicate use of vacutainers straight from the port). I've tried connecting a vacutainer to the syringe using a large needle but it ended up being messy and doesn't seem right. I've read of nurses pulling the top off of the vial and squirting the blood into vial fromthe syringe then recapping, but can't find any literature to support this (or rule it out). In fact while there is tons out there on the actual draw there is very little on getting the blood into the vials once you've done the draw. Any advice?

I'm curious as to why your facility doesn't allow you to attach a vacutainer adapter to the port.

When you say 'large needle' are you talking about a blunt needle? The only conceiveable thing I can think of would be inserting a blunt needle into the vacutainer and allowing suction from the vial to draw the blood from the syringe. I'd imagine things got messy because you were forcing blood against the suction of the vial.

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Specializes in Emergency Department.
jenngrove said:
This is an old post so I may not get anything, but can't hurt. My question is transferring blood from the syringe into the vials (my facility doesn't indicate use of vacutainers straight from the port). I've tried connecting a vacutainer to the syringe using a large needle but it ended up being messy and doesn't seem right. I've read of nurses pulling the top off of the vial and squirting the blood into vial fromthe syringe then recapping, but can't find any literature to support this (or rule it out). In fact while there is tons out there on the actual draw there is very little on getting the blood into the vials once you've done the draw. Any advice?

At the top of the page (and perhaps previous pages) there's a picture of one kind of transfer device that you attach to your sample syringe and then push the vials onto the syringe. While I could use a large bore needle to do the same thing, that can get messy (as you've found out) and opening the vial potentially contaminates the interior of the vial. I've done blood draws using a needle and syringe, needle and vacutainer adapter, and most commonly these days, an IV catheter, extension set, syringe and syringe adapter that's pictured above. I've only done a couple draws from a PICC or Central line and it's been flush 10, draw/waste 10, obtain sample, flush & lock with appropriate heparin or saline fluid.

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Specializes in Pediatrics, Emergency, Trauma.
flyersfan88 said:
I'm curious as to why your facility doesn't allow you to attach a vacutainer adapter to the port.

Per my facility, as well as best practices, a vacutainer attached to a port or central line interferes with pressure of the lumen and may present air emboli-we don't want that. :no:

Quote
When you say 'large needle' are you talking about a blunt needle? The only conceiveable thing I can think of would be inserting a blunt needle into the vacutainer and allowing suction from the vial to draw the blood from the syringe. I'd imagine things got messy because you were forcing blood against the suction of the vial.

Agreed-most times when I draw from a central line, a blunt tip is used, or a transfer device:

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Specializes in Trauma, Orthopedics.
LadyFree28 said:
Per my facility, as well as best practices, a vacutainer attached to a port or central line interferes with pressure of the lumen and may present air emboli-we don't want that. :no:

I didnt know that so I'll have to look into that! Thanks!

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

I know this is an old thread, but I don't think that is possible unless you filled tubes with the waste syringe accidentally.

At my hospital we flush with 10 mL (20 if they are on TPN), and then draw 5 mL of waste.

Annie

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