Picc Line- Tpn

[epappyRN]

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

[TexasPediRN]

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.

Curious on this -- you dont give back the waste?

It may be because I do pedi, but we draw back 5 cc as the waste, then draw back the 1-2 cc's for labs, then give back the initial 5cc waste. (Then flush with saline and heparin).

That way, we dont deplete them of any blood except the 1-2 cc we drew off for labs..

[GrumpyRN63, ADN, RN]

Your technique sounds just fine, so I would hypothesis something else is causing such H/H discrepancies, If he didn't get transfused at his MD's, my other thought would be he was dehydrated on monday, doe she get any other fluids? Is his TPN cycled @ noc and have a long period of time p which he isn't getting fluid and the H/H could reflect that, as well as any diuretic? Is he receiving chemo ? are his labs reflective of a nadir 2/2 chemo/ or other bone marrow suppresion? Is he on Procrit or Epogen. Is he in renal failure or on dialysis...

I think it isn't your technique in the least but there would be many variables unknown ( to us) at this time 2/2 his med hx and treatment plan that make it difficult to formulate a conclusion on his lab values.JMHO

[GrumpyRN63, ADN, RN]

Curious on this -- you dont give back the waste?

It may be because I do pedi, but we draw back 5 cc as the waste, then draw back the 1-2 cc's for labs, then give back the initial 5cc waste. (Then flush with saline and heparin).

That way, we dont deplete them of any blood except the 1-2 cc we drew off for labs..

Not in my place of employment, never w/ adults, I have no idea in Peds...

[preciousmofo]

I think giving the waste back is a peds thing. Or a special case scenario.

[IVRUS, BSN, RN]

Curious on this -- you dont give back the waste?

It may be because I do pedi, but we draw back 5 cc as the waste, then draw back the 1-2 cc's for labs, then give back the initial 5cc waste. (Then flush with saline and heparin).

That way, we dont deplete them of any blood except the 1-2 cc we drew off for labs..

The only way I would employ this reinfusion method is if I had NOT disconected the syringe with my waste from the patient.

Best practice is not to reinfusion a syringe filled with blood if you have disconected it from the IV catheter. You see, the main concern that all should be fretting about here is reinfusing clots that have formed in the waste specimen that you've set aside.

I propose a different method for reinfusing the waste... Keep the syringe connected to your IV catheter and then do the mixing method: Withdraw approx. 4-5cc of blood into your syringe and then without detaching, reinfuse it. Do this "mixing" method three to four times then draw your specimen and then flush your line with the appropriate solution(s). When you detach and set the syringe aside, you also should be concerned with contamination of the syringe (especially if it was not capped after disconnection).

Hope this helps.

DD

[august07]

We turn all fluids off for 2 minutes before drawing blood from a PICC. Flush with saline, waste 3ml, then collect sample. If you forget to turn off the TPN and draw blood, usually the potassium is the valus that's way off, not the H&H.

[siggie13]

Curious on this -- you dont give back the waste?

It may be because I do pedi, but we draw back 5 cc as the waste, then draw back the 1-2 cc's for labs, then give back the initial 5cc waste. (Then flush with saline and heparin).

That way, we dont deplete them of any blood except the 1-2 cc we drew off for labs..

Yes, when I have to drawn from a peds patient, I do reinfuse the "waste" amount and I prefer doing this when I have more than one ports so I don't have to disconnect the waste syringe. I have had doctors request that we reinfuse the waste to maintaine the patient's H&H.

[cardiacRN2006, ADN, RN]

I don't think this guys H/H is low due to technique. I think it's low and he needs to be treated.

[lorilou22RN]

Yes waste at least 10cc's, and WAIT before drawing your labs! use your red port too, and don't draw from your TPN designated line.