Picc Line- Tpn

siggie13 · Jan 2, 2008

If you turn off all fluids and flush with saline 30 cc, pull back at least 3cc of blood/fluid, discard this, then aspirate the amount of blood you need for tests. Always waste the first 3cc of aspirate as this has the IV fluids and saline in it. Of course, this takes two syringes. Be sure and flush PICC after you aspirate the blood to insure patency.

beachmom · Jan 2, 2008

I've never drawn labs on someone getting TPN. Can you ask the lab for the proper protocol?

The best plan would be to ask your employer to have you trained in PICC lines. It is important to do everything correct with them.

Or since you are a new nurse, working basically alone in people's homes, is there a more experienced nurse who you could call with questions? I have been a nurse 2 1/2 years, and even if I'm pretty sure I am right, I will often ask an experienced nurse to double check my decisions.

naijanurse · Jan 2, 2008

I need help- I am a new nurse and have only worked in Critical Care- Now I am doing home health and I am not familiar with Picc lines. If there is a triple lumen picc line that a pt is recieving TPN if you flush the line and wait... and use a different port ... could it mess up lab values... The only value that has been off is H&H.... help... the man has 0 veins to stick

Usually when you draw blood from a PICC line, you need to turn off all other IV fluids running through the PICC. The reason being, is that lab values can end up being inaccurate. The H&H was probably off because it was dilutional due to the fact that fluids were running while you drew your blood (even if the tpn was running through a different lumen, it will still dilute the blood). TPN can affect all lab values especially Chem 7s so it is always best to turn off or put the TPN on hold, flush another lumen with 10ccs of saline, draw up a 10cc waste, and then draw your blood for labs.

hope this was helpful!

Tait, MSN, RN · Jan 2, 2008

I would say (which mostly agrees with previous posts) according to protocol I have run into:

1.) Turn off fluids

2.) Clamp the line to avoid air getting through the selected port.

3.) Remove the port cap if it has one and flush and draw directly off the line (less chance for hemolysis of the cells as they pass through any type of cap). (Bring a new cap with you to replace it with)

http://www.devicelink.com/company98/enhanced/h/images/h00013_b.jpg

4.) Swab port with alcohol swipe.

5.) Attach a prefilled 10mL syringe, unclamp and flush.

http://www.excelsiormedical.com/excelsior/images/products_photo.jpg

6.) Using same syringe pull back 10mL, clamp line, remove and waste.

7.) Attach empty syringe, unclamp and draw sample.

8.) Clamp line, remove sample syringe, apply clean, new flushed cap.

9.) Unclamp, flush line and restart fluids/TPN etc.

That is a mix of my logic and protocol I have worked with.

Tait

jnrsmommy · Jan 2, 2008

Also, check your facility P&P, and any information regarding the PICC that your pt has. I've come across a few pts that have the manufactures info on their chart and these state how much to waste and flush with. I was taught to flush w/ 10-20mL and waste 10mL. Some of the ones I've recently encountered say to flush w/ 5-10mL and waste 3-5mL.

GrumpyRN63, ADN, RN · Jan 2, 2008

I always wait 2 minutes after shutting running lines off and always waste a full 10 cc's

siggie13 · Jan 2, 2008

Also, check your facility P&P, and any information regarding the PICC that your pt has. I've come across a few pts that have the manufactures info on their chart and these state how much to waste and flush with. I was taught to flush w/ 10-20mL and waste 10mL. Some of the ones I've recently encountered say to flush w/ 5-10mL and waste 3-5mL.

In dealing with patients with low H&H, we only discarded 3cc to save the patient's blood level. If the patient is stable, we discarded 5cc before saving any aspirate.

epappyRN · Jan 2, 2008

The exact way that I do this is..... The TPN runs thru the medial port (triple lumen)... It is time to change the tpn anyways so I just clamp port and discard tpn. I then flush medial port with 10 ml of ns. I go ahead and flush each of the 2 unused ports with 10 ml of ns each. I then go ahead and do my dressing change, visit etc. About 20 minutes later I waste 10 ml from the distal port then draw my blood. Pt is not recieving any other fluids... I would understand the glucose being messed up... but the H&H?? I have done this hundreds of times with central lines... I just was not sure if a picc line would be different??

epappyRN · Jan 2, 2008

The exact way that I do this is..... The TPN runs thru the medial port (triple lumen)... It is time to change the tpn anyways so I just clamp port and discard tpn. I then flush medial port with 10 ml of ns. I go ahead and flush each of the 2 unused ports with 10 ml of ns each. I then go ahead and do my dressing change, visit etc. About 20 minutes later I waste 10 ml from the distal port then draw my blood. Pt is not recieving any other fluids... I would understand the glucose being messed up... but the H&H?? I have done this hundreds of times with central lines... I just was not sure if a picc line would be different?? His hgb was 7 last wed, saw md on Fri ... 11 on Monday and 5 today?!?!

EmmaG, RN · Jan 2, 2008

And no transfusion between last Wednesday and Monday?

Strange. You're clamping the other two lines after flushing and during the waste and draw?

Daytonite, BSN, RN · Jan 3, 2008

i need help- i am a new nurse and have only worked in critical care- now i am doing home health and i am not familiar with picc lines. if there is a triple lumen picc line that a pt is recieving tpn if you flush the line and wait... and use a different port ... could it mess up lab values... the only value that has been off is h&h.... help... the man has 0 veins to stick

no. the distal end of the picc line is in the vena cava of the heart, the same place where the distal end of a triple lumen is, so the blood is very well mixed due to the turbulence of the blood and the constant flow of the blood through that area.

it was very hard for me to find articles about picc lines on the internet, but there were a few. the links to them are posted on post #6 of this thread: https://allnurses.com/forums/f205/any-good-iv-therapy-nursing-procedure-web-sites-127657.html - any good iv therapy or nursing procedure web sites (in nursing student assistant forum)