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?

[blondy2061h, MSN, RN]

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...

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I've never heard of wasting 20 ml with every blood draw. We've had patients on q2h blood draws. Could you imagine the iatrogenic anemia? And we don't change caps with every blood draw. That's facility specific and against policy at my facility. It is considered an infection risk to open that up more than necessary.

The thing that I don't see you mentioning in the OP, is were there fluids running? And did you pause those and clamp the other lumens if it was a two or three lumen PICC?

[IVRUS, BSN, RN]

blondy2061h said:

I've never heard of wasting 20 ml with every blood draw. We've had patients on q2h blood draws. Could you imagine the iatrogenic anemia? And we don't change caps with every blood draw. That's facility specific and against policy at my facility. It is considered an infection risk to open that up more than necessary.

The thing that I don't see you mentioning in the OP, is were there fluids running? And did you pause those and clamp the other lumens if it was a two or three lumen PICC?

You are right Blondy.. If IVF were infusing in a lumen, they should be stopped for a full minute prior to the blood draw. I also would worry about iatrogenic anemia if one was wasting 20 cc each time a blood draw was being performed, but as I mentioned in a previous post, one researcher stated that if one MUST draw coags from a Heparinzed line, to get the most accurate results, withdraw approx 25 cc then grab the sample and flush with 20cc NS s/p.

If the patient required frequent lab analysis, that patient could have severe issues with blood loss with that much withdraw. Ideally, therefore, do a peripheral IV stick.

[blondy2061h, MSN, RN]

IVRUS said:

You are right Blondy.. If IVF were infusing in a lumen, they should be stopped for a full minute prior to the blood draw. I also would worry about iatrogenic anemia if one was wasting 20 cc each time a blood draw was being performed, but as I mentioned in a previous post, one researcher stated that if one MUST draw coags from a Heparinzed line, to get the most accurate results, withdraw approx 25 cc then grab the sample and flush with 20cc NS s/p.

If the patient required frequent lab analysis, that patient could have severe issues with blood loss with that much withdraw. Ideally, therefore, do a peripheral IV stick.

We don't hepranize any lines except ports, and even then, only when discontinuing access due to the risk of HIT, so that's not a concern at my facility.

[Neural]

Our nursing school and hospital policy states:

*Alcohol swab the cap

*Flush 10mL (policy is to ALWAYS flush PICCs with 10, whereas we normally flush IVs with 3mL)

*Waste approx. 6mL of blood

*Draw blood sample

*Flush 10mL

*Alcohol swab the cap (presumably to remove the tiny bit of blood residue)

[onedayitllbeme]

Wow I'm shocked a place would have you waste 20ml for a blood draw. I hope there is an exception for GI bleeds and other anemias. If a patient is a reasonable stick I actually prefer peripheral blood draw in these patients to avoid the blood loss of wasting. Of course many have the piccs because of poor venous access.