PICC line?

[2008el]

pls some one tell me what is the safest way to draw blood from PICC line. what should i use? thanks!

[jamonit]

What we do per policy at the facility where i work is the following:

clean PICC port very well with alcohol

Flush with at least 10 ml of normal saline

use at least a 10 ml syringe

lure lock syringe to PICC, if open-ended, open port's clamp

withdraw at least 6 ml of blood (i usually do 10 ml)--this is the waste to discard

next reclamp port, use alcohol on the lure lock and attach an empty 10 ml syringe

pull back needed amout of blood (usually 3-4 ml per tube), close clamp

take that syringe and attach a safety needle of a larger bore

VERY CAREFULLY pierce tube with needle and allow vacutainer mechanism to fill tube

after tubes are filled, label at bedside

then flush with at least 10-12 ml of NS and if it's open-ended flush with 2-5 ml of heparin

if drawing aptt from line, have heparin off for at least 5-10 minutes prior to drawing and then flush with 20 ml of NS.

hope that helps:idea:

[iluvivt, BSN, RN]

I would just like to add a few more details to the previous post....but it is good advice

1. When flushing the PICC after the blood draw...use a pulsatile push pause method. This really cleans out any CVC and minimizes occlusion.

2. If you have a non-valved open-ended PICC line with a positive displacement valve or cap...you must always flush disconnect and then clamp the line in that order so as not to lose the benefit of that type of cap. So in other words do not clamp and then disconnect

3 It is necessary to shut off ALL infusions and IV medications going through the PICC for at least ONE FULL MINUTE. With the volume of blood dumping into the superior vena cava extended shut off times are not necessary and many patients cannot tolerate their medications being turned off for this amount of time and it is not necessary to do this.

4. Be prepared with all supplies at the bedside

5. Always label the specimen at the bedside

6 do not inadvertently use the discard for sampling. Set this aside in a different location after you get it. I can not tell you how many times I have seen this happen.

& Always Always perform a a good cap scrub before attaching your syringes

[RN1982]

If I'm drawing from a picc that has heparin infusing I just shut it off right before I draw blood. I flush with 20cc of NS and waste 10cc of blood, had no problems with skewed aPTT levels. I guess everyone has their own technique.

[iluvivt, BSN, RN]

In the INS protocols it is recommended to shut off all infusion (not just heparin) for one full minute. Then you are assured accurate results. It is not a matter of personal preference, it has to do with the physiology of the blood flow in the Vena Cava. That is truly best practice.

[jamonit]

I just referenced Heparin as I am a cardiac nurse. We turn heparin off for at least 5 minutes.

I agree with turning any drip off for at least a minute and flushing the port well.

Be careful with flushing dopamine/dobutamine. I don't recommend doing that!:redpinkhe

[futrarmyCRNA]

Be careful with flushing dopamine/dobutamine. I don't recommend doing that!:redpinkhe

yes I found that out the hard way!! Patient was no longer on Dopamine and stopped before I took over but was still apparently in one port line. The flushed one port of CL and all of a sudden heart rate went up and ABP went up!!! Always check to see what gtts your patient was recently stopped of.

[RN1982]

I always check to see which drips are compatible and I run them together through one or two ports. Usually, most patients will have a triple lumen central line or an arterial line, so I'll draw from the CVP port or the a-line port.

[RheatherN, ASN, RN, EMT-P]

i agree with everyone, but FIRST, you need to check hospital policy. have someone show you, thats the best way, then you can see it before you do it. GL!

-H-RN

[Daytonite, BSN, RN]

Your facility should have a written protocol. You need to look it up. If they don't then you should chart exactly what you do and push for a procedure to be added to the facility procedure manual and get a doctor's order to draw from this patient's PICC line.

INS standards are not specific, but this is exactly what the current standards do say (page S72, Infusion Nursing Standards of Practice, 2006)

• "C. Infusions should be stopped prior to phlebectomy.
  
• D. Blood sampling should not be performed through an infusion administration set.
  
• F. Only the volume of blood necessary for accurate testing should be obtained in order to avoid patient compromise.
  
• G. Vascular access devices should be flushed with preservative-free 0.9% sodium chloride (USP) postphlebotomy."

What they don't say is how much blood should be initially withdrawn and discarded. Where I worked we always withdrew 2 mL if nothing was infusing on the line (5 mL if there were IV fluids infusing) and flushed afterward with 10 to 20 mL of saline, the more the patient could safely tolerate the better. I flushed with 10 mL with my own PICC line when I had one for chemotherapy.