vpierre

again every one this is talking about pivc not picc. thanks!

I was talking about a peripherally inserted venous catheter (PIVC) not a PICC. Some people call it a prn adapter, iv, peripheral iv

I am not a jail nurse, but maybe I can shed some light on the matter. I work in ICU, and sometimes we can order certain things without an MD order. Example: I can write for some zofran, morphine, a cepacol tab, ect.. and for non-pharmaceuticals items such as a foley catheter or an NG tube although I should have an MD order. Just like she said "as long as it wasn't anything "crazy"" I can write the order and the MD can sign it off in the am. Although there are many things you should take into account: 1.Which MD will be signing off on it. you have to have a relationship with that MD assuming that they trust your judgement and they are ok with you doing that sort of thing. 2. Use great nursing judgement. You don't want to gice the patient morphine to a patient who have never have it before, then you'll be the first one to find out that they have an allergic reaction to it. (so it will be great if the order was just D/C). I would say, if you're not confortable with it, then don't do it. you cannt get an trouble for calling an MD for an order, but you can get in big trouble for administering med without an order.

thank you for your replies which makes perfect sense. i did look on my p&p but could not find anything addressing this issue. i will e-mail my educator. anyone have anything more evidence base answers? thanks! so far this is what i’ve learned: 1. blood sample taken from pivc have a higher rate of hemolysis. 2. drawing increase the risk of losing the site 3. it is common practice in pediatric patients and patients who have received tpa, and patient not candidate for phlebotomy. 4. “blood that is near the iv is not good for sampling anymore because it doesn't flow/mix at the same rate” (expathopeful, 2008) 5. “as the catheter is in place in the vein, it warms and becomes somewhat softer and could collapse with the vacuum of either the syringe or the vacu-tainer” (emboss, 2009).

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I am also new in the ICU (1year). But when inserting a quad lumen for example, every line is flushed with a 10ml of normal saline equal 40ml upon initial insertion before x-ray confirmation. The pressure bag on a CVP is flushed with 3ml/hr when it is hooked up. So you may not want to administer any fluid with a volume but a CVP is ok.

My floor is starting to have the ICU nurses draw their own labs. Usually the nurse would have the phlebotomists from the lab come up to do a venipunture, unless the patient had some sort of central line in place, then the nurse will do the draw. So now that we have to draw our own lab, most of the nurses are drawing from peripheral IV catheter (PIVC). I always thought that it was ok to draw from PIVC only upon the initial insertion of the catheter, and then you have to do venipunture thereafter. On a previous post, it was mentioned that “the blood that is near the IV is not good for sampling anymore because it doesn't flow/mix at the same rate” is that the evidence based answer? So my questions are: 1. What is the common nursing practice out there? 2. If it is common or uncommon to draw from PIVC: what is the rationale?