piccemrn1

If the patient is in the ICU and on special infusion ie, vanco, heparin, or any other infusate that can "skew" lab data, we are always careful to label this line as such and draw from a separate line. However, if you know of any data that supports lab results are altered due to "residual" infusate composite on the picc line, I would love to have it! Our manufacturer states no such claim (biased? maybe..) Sometimes, I have patients who return from home infusion therapy and they often have a single lumen, so it becomes necessary to draw from the only line they have.

Actually, if the inserter infected the patient, literature strongly suggests the infection will manifest with 24-48 hours. Any time beyond that, it can be line manipulation, lack of hand hygiene or access technique. If an infection is suspected, check xray for PNA, urine, or wound/source..If picc line is still suspected draw 2 sets; one directly from the line and a peripheral, then culture your tip. It is also recommended to wait 24-48 hrs before placing another line.

You have been extremely helpful. You are awesome, and thank YOU!

You might want to check with your State Board to identify what your scope of practice is. It will be even harder to swallow if you get called to court. In California only an RN can push meds through an IV. "because the doctor said to" will not save you when on a witness stand.

INR of 3 is therapeutic for so many patients.

this is rather late, however, my facility does not approve use of "midclavicular" catheters, d/t catheter whip, etc. and I am pretty sure INS states a picc line must be placed in the distal 1/3 of the svc. as stated above by another comment we will try the other arm or opt for IR placement. tpn should never be infused through a line other than central, at least at my facility and most others. (i know i should never say never..but there it is)

I am in the process of updating our P&P for PICC Insertion and Maintenance in the hospital. I have done extensive literature searches regarding blood sampling from central lines. What I have concluded is: 1. don't draw coags from a line that has ever had heparin infused, and 2. dedicate ONE line for tpn/vanco(or med requiring peak/trough)/heparing gtt.--Is this true?? There is mixed statements on this. So here is my question(s). Can you draw blood from a closed ended catheter (ie groshong) as long as you dedicate this specific line for blood draws. Or is it acceptable to draw blood from a line infusing something else as long as you vigorously flush using 20 mls of normal saline (extrapulated from literature), and waste 3-5 mls first? Does anyone know if there are national standards or INS guidelines that dictate this practice?? Can you draw any lab from an open ended central line as long as you flush with normal saline first? Can you infuse dilantin into a picc line as long as it is admixed with NS?? without running risk of crystalizing? Our Neurologist says YES! Please help! thank you in advance. And...can you draw blood from midlines? :typing?