Picc Line Question

[sophtheorn]

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!

[Morainey, BSN, RN]

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.

[LAJRN06]

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]

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]

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]

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]

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.

[KelRN215, BSN, RN]

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?

Nope, have never returned the waste to the patient.

[CodeteamB]

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?[/quote']

We waste blood off central lines, the only way that we return blood is through a vamp on an arterial line. For a normal adult the amount wasted is going to be no big deal.

[bamaguy1989]

I was always taught flush with 10 ml NS, waste 10, get 10 for blood draw and flush with 10 ml NS. And that is what I always do when I draw from Piccs or CL

[MunoRN, RN]

We waste blood off central lines, the only way that we return blood is through a vamp on an arterial line. For a normal adult the amount wasted is going to be no big deal.

Iatrogenic anemia is actually one of the main causes of hospital associated mortality. The even bigger issue is that it's not your blood to waste, someone else's own blood deserves some respect.

[MunoRN, RN]

I was always taught flush with 10 ml NS, waste 10, get 10 for blood draw and flush with 10 ml NS. And that is what I always do when I draw from Piccs or CL

Dont' waste 10ml. The amount required to get a clean sample is 2-3 times the lumen volume; usually 5ml or less.

[blondy2061h, MSN, RN]

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.

My facility's policy is a 10ml waste too. I usually do more like 7 because 10ml does seem excess, but it's awfully harsh to tell someone she is being abusive for following policy.

I'm more concerned that some places have people taking off the cap to draw blood. The cap is a major barrier to infection. We only take them off the change them and that's with sterile gloves and masks.

Out policy is no vacutainers on PICCs. They exert too much pressure and could burst the lumen.