Jump to content

Picc line question

Posted

I'm a recent new grad and I am kind of confused about picc lines. If you have a double lumen picc line does it matter which side you use for blood draws/infusions or are they the same?

Also, are you supposed to take the cap off to draw blood or do you just attach the vaccutainer (sp?) right to the cap?

Thanks!

1. You can use either one of the ports. I have found that its easier to get blood from the white port. (Maybe it's a preference)

2. You don't have to take off the injection caps also known as "deadheads" when drawing blood unless it is ordered for blood culture through a picc line. Again, this would depend on your hospital policy.

3. First step is to flush the picc line with 10ml NS. Then, withdraw 3-5ml of blood to waste. Obtain a 10ml syringe and fill it up (or depending how much the lab personnel needs. Usually, 10 ml is sufficient). Then flush the port with 10ml saline again so the blood doesn't clot on the line.

I just attended an in-service on this today. Technically you are supposed to reserve one lumen for blood draws, the other for meds. I've seen some specifically ordered that way, and others not addressed. I also learned today that you are to scrub the port for 15 sec. prior to use, flush 10 ml NS before a draw, and waste the first 10 ml of blood. You remove the cap to draw blood, then you toss and replace with a new cap.

Tait, MSN, RN

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 14 years experience.

This is all pretty specific to the facilities policies.

SwansonRN

Has 2 years experience.

Double lumen PICCs rock :) especially freshly placed and verified. Beautiful blood return and if you need to start pressors or run something like KCl or calcium gluconate you're golden. You can technically draw labs from either port as long as both lumens are patent and one isn't dedicated to TPN. Remember to waste! I always waste at least 5-6mL if its sluggish, but usually a full 10mL. Also be sure to hold any infusions on the other port when aspirating blood. You don't want calls from the lab with critical glucose levels because you forgot to pause your TPN going into the other port ;).

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Double lumen PICCs rock :) especially freshly placed and verified. Beautiful blood return and if you need to start pressors or run something like KCl or calcium gluconate you're golden. You can technically draw labs from either port as long as both lumens are patent and one isn't dedicated to TPN. Remember to waste! I always waste at least 5-6mL if its sluggish, but usually a full 10mL. Also be sure to hold any infusions on the other port when aspirating blood. You don't want calls from the lab with critical glucose levels because you forgot to pause your TPN going into the other port ;).

Why are you wasting 10mls? Blood is valuable stuff.

Sun0408, ASN, RN

Specializes in Trauma Surgical ICU. Has 4 years experience.

I use which ever port that will draw. I flush, waste and then attach a 10ml syringe to get my sample. Facility policy will dictate if you take the cap off or not and when to change the caps..

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 20 years experience.

Why are you wasting 10mls? Blood is valuable stuff.

Our policy is to waste 10mls.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Best practice is to waste 2-3 times the lumen volume. The largest volume PICC lumen, a POWER lumen, is 1.7mls, 3 times that is 5.1 mls. Given the known threat iatrogenic blood loss poses to patients, wasting twice the recommended amount is borderline abuse.

Our policy is:

Remove cap, scrub with alcohol, flush with 10 mls, waste 5 mls, draw blood (usually just 10 ml's), replace cap and flush with 20 ml's. we are not allowed to use a PICC for blood draws at all if the patient is getting TPN. Also never use a syringe smaller than 10 mls.

Seems pretty consistent with most everyone's answers.

psu_213, BSN, RN

Specializes in Emergency, Telemetry, Transplant. Has 6 years experience.

You remove the cap to draw blood, then you toss and replace with a new cap.

This is definitely variable from facility to facility based on policy. For example, at my facility you don't remove/change caps with each blood draw.

SwansonRN

Has 2 years experience.

I think the best thing is to know your agency's policy because as you can see practice varies from place to place.

Morainey, BSN, RN

Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

Yeah, we do the most complicated PICC line draw in the world at my facility. I bet you could your pharmacy or lab or charge nurse, and they would know.

I'm a recent new grad and I am kind of confused about picc lines. If you have a double lumen picc line does it matter which side you use for blood draws/infusions or are they the same?

Also, are you supposed to take the cap off to draw blood or do you just attach the vaccutainer (sp?) right to the cap?

Thanks!

I used to work with a surgeon that always wanted the brown lumen for blood "brown is dirty so is blood" he would say and white lumen for tpn "white is clean and so is tpn". I also was taught that you don't remove cap to draw blood but you do change the cap after every blood draw and dressing change.

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

I've never used a vacutainer to draw blood from a PICC line. 10 cc syringe ONLY. Blood is drawn through the cap and the caps are not changed after every lab draw. In my experience, caps are changed q 96 hrs or twice/week.

When I draw blood through a PICC, I do so as follows:

1. Flush with 10 cc normal saline

2. Draw waste (I draw it right into the saline syringe so as to not confuse the waste with the sample.)

3. Draw specimen

4. Flush with saline again.

5. Flush with 2-3 mL of 10u/mL heparin

Of course you scrub with alcohol x 15 seconds between each step.

This varies by facility and, in my experience, every facility believes their way is the only way/the right way so it's best to just follow your facility's P&P.

Penelope_Pitstop, BSN, RN

Has 13 years experience.

My concern is that your preceptor hasn't gone over this with you. In my facility, a four hour class must be taken before any hired RN can even touch any sort of central line.

Are there no resources at work for you?

KJM-RN, BSN

Has 2 years experience.

I'm almost a new grad and the facility that I am doing clinical at uses a 3 way stop cock. Flush the line with NS, 'waste' the blood, take your blood sample, push the 'wasted' blood back into person, then flush again. This way no blood is actually wasted, is a 3 way stop cock not what most hospitals supply?

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 20 years experience.

I'm almost a new grad and the facility that I am doing clinical at uses a 3 way stop cock. Flush the line with NS, 'waste' the blood, take your blood sample, push the 'wasted' blood back into person, then flush again. This way no blood is actually wasted, is a 3 way stop cock not what most hospitals supply?

Not at my facility. We don't use a vamp on all arterial lines either.