Pt w/ a PICC line on a heparin gtt

[NurseCherlove]

I am not a new nurse, and yet I still do not know the definitive answer to this question since I've heard so many nurses argue both sides. The question: Is it ok to draw a ptt from a PICC for the pt on a heparin gtt? That is, if you flush w/ 10cc and discard 10cc, have the heparin off for like 10 minutes or so, and draw from the lumen that did not have the heparin infusing?

Like I said, many nurses have no problem doing that and then there are others who are adamant that a ptt must be obtained via peripheral stick. So what do you do and why? Thanx.

I will tell you all that I did see a similar thread on this topic posted about a year ago and someone made a comment something to the effect that the body's response to venipuncture affected clotting factor levels. Very insightful. Any thoughts to add to this?

[Mulan]

A lot of times the reason a person has a PICC is because they have such lousy veins you can't get any blood peripherally.

[RNNPICU, BSN, RN]

We temporarily stop the infusion, draw off about 10ml first, draw the sample with the amount needed, give the 10ml blood back then a slow small amont of NS flush just enough to clear the line, then start the infusion again. We are able to have the lab hep reduce the sample if needed.

[NeosynephRN]

At my hospital we never draw a PTT off a PICC....unless we HAVE to. I have gotten many conflicting veiws on this, some nurses say it is fine, just not the way that we do it...others say absolutely not. I am no help huh. Also we have standing orders to put a PICC in everyone on our floor, if we feel it is needed, so most people get one regardless of how easy or hard a stick they are.

[cardiacRN2006, ADN, RN]

We had a problem with people NOT turning off the heparin first, so one time we stopped the heparin, wasted our blood, and sent a sample along with a peripheral stick.

Both results were the same (give or take a second).

As long as it's done properly, then it should be ok.

[chenoaspirit, ASN, RN]

We have to wast 20 ml prior to drawing any coags from a picc. And we dont return that blood, we waste it in the sharps container. Alot of blood to waste, if you ask me.

[miko014]

Also we have standing orders to put a PICC in everyone on our floor, if we feel it is needed, so most people get one regardless of how easy or hard a stick they are.

Please don't take this the wrong way, but that is scary. I don't know what kind of floor you are on, but nobody should have a PICC if they don't need it. So unless they are a terrible stick or getting something like TPN which would require a central line, they shouldn't have a PICC. Too much risk for infection or other complications!!! I'm sure that you don't, but there are probably nurses who put one in everyone just for the convenience of it. At my hospital, the pt has to meet specific criteria to get one.

Sorry....:offtopic:

[NurseCherlove]

We temporarily stop the infusion, draw off about 10ml first, draw the sample with the amount needed, give the 10ml blood back then a slow small amont of NS flush just enough to clear the line, then start the infusion again. We are able to have the lab hep reduce the sample if needed.

I've often wondered about that one too....giving the blood back. This would definitely seem appropriate for the patient getting serial H&Hs. I've just never heard of people doing this. Aside from the obvious (contamination), anyone know of any other associated risks? Maybe I'll start doing that since I care for a lot of pretty compromised patients.

[MoopleRN]

My hospital policy is NO ptt/inr draws off a PICC on a heparin drip regardless of the number of lumens. Our rationale is that even an unused port of a PICC has a heparin flush q 12 hours to maintain patency so drawing off the heparin drip port, even stopping the heparin for however long/flushing..... we just don't do it. Oftentimes lab will come up in the morning to draw, see the PICC and try to get us to draw but if a ptt/inr is what's ordered, we have to tell lab they have to do a peripheral stick. This is usually met with a frown, especially if the patient DOES have an order it's ok to draw from the PICC for labs (unless, of course, the lab in question is/includes a ptt/inr).

My hospital's P&P NEVER allows "giving the blood back". Flush, draw off 5 mL and discard, draw off the sample, flush, heparin flush, and change the Q-syte on PICC lines or PACs is our policy.

[NeosynephRN]

Please don't take this the wrong way, but that is scary. I don't know what kind of floor you are on, but nobody should have a PICC if they don't need it. So unless they are a terrible stick or getting something like TPN which would require a central line, they shouldn't have a PICC. Too much risk for infection or other complications!!! I'm sure that you don't, but there are probably nurses who put one in everyone just for the convenience of it. At my hospital, the pt has to meet specific criteria to get one.

Sorry....:offtopic:

That is probably true. I am on an ICU..so the vast majority of our patients need one...long term mulitple antibiotics..drips, and lots of fluids. We do not give them to everyone...like my pp made it sound. Our stable patients that will transfer within days, our OD's etc..they just keep their PIV's

[WSU_Ally_RN, BSN, RN]

If I have a pt with a PICC line, I will attempt to get a peripheral access in the other arm, so we can draw our ptt's q6hours. If we are unable to obtain another access, I will draw my Ptt off the PICC, but only after placing the heparin on hold for a few minutes, and giving a large flush (at least 10cc) and a large discard (again, at least 10 cc), then get my sample.

[jmgrn65, RN]

I have seen to many ptt come back inaccurate due to the ptt being drawn from the line.