Question: Drawing Blood from Portacath

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Is blood ever drawn from a portacath?

(context: person has portacath & gets blood drawn weekly but has been stuck so much, veins are shot).

Is the infection risk w/a portacath any more or less than drawing blood through a PICC or Hickman?

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Yes, blood is drawn from a port the same way you'd draw off any other central line (PICC, Hickman, etc). Ports are often inserted specifically on patients whose veins are horrible (extended treatment, poor circulation, etc) so that they don't have to be constantly stuck for blood and IV purposes. You're telling me this patient has a port and it isn't being used for blood draws? On the floor I came from, that'd be inexcusable.

Ports have a similar risk of infection to any other central line. The nice thing about a Port is that you can remove the Huber needle and the site heals, so you don't have the hassle and infection risk of a PICC line for example where you have a catheter sticking out of the patient's arm at all times.

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Specializes in -.

Thanks for your reply...

This is not a hospital setting.

Patient has the port for TPN... (Crohns/short bowel). Does TPN at home every night.

Had a PICC for a while w/no trouble (no infections) but it was removed at one point & replaced with the port. Why it was removed is a whole other story but the reason why the port was put in as opposed to another PICC was because they were having trouble putting in the PICC.

So what is bothering me is that this person gets stuck every week (at quest or whatever before going to work) & she is running out of veins. If blood can be drawn from port, why not?

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Okay, I'm completely re-working my response here since I saw your second post after I posted my original response....

Yes, blood can be drawn from a portacath, but some studies such as coags, medication peaks and troughs, and chem studies in a patient receiving TPN should be drawn peripherally because the results can be inaccurate when drawn through the portacath.

Also, in the state where I practice, phlebotomists may not access central lines. They can only draw peripherally.

So yes, it is totally reasonable that this person is having their blood drawn peripherally. Even if an RN came out to the house to do port maintenance, they would still draw chem studies peripherally in this patient, for the reason I stated above.

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In my state, only licensed nurses can draw off a portacath

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Specializes in -.

"Yes, blood can be drawn from a portacath, but some studies such as coags, medication peaks and troughs, and chem studies"

The only thing that is ever discussed is Creatinine, E-, & hydration. And since I've been changing the needle since last May (no line infections... knock on wood), it would make this person's life much easier for me to just draw & drop off at lab myself. And better for her veins which is the real concern.

I'm pretty sure the endocrinologist is worried about the infection aspect & he doesn't trust the phlebotomists at the walk in place even if they are allowed to do it legally. So I want to advocate here but I really need to know what I'm talking about before I make a case to the doctor.

Thank you all for your replies...

(always happy to get more insight)

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This thread is feeling to me like it's bordering on medical advice, which is against TOS. I suspect that you might be asking for medical advice for your wife rather than discussing a patient situation that you encountered in your work as an RN. Pardon me if I am off base.

I will say though, that hydration status is monitored using a chem panel (includes electrolytes, BUN & Creatinine, glucose, etc.) which in a patient receiving TPN should be drawn peripherally because TPN contains electrolytes and glucose (and lipids), so if you're drawing off the portacath the results can be skewed. Also, electrolytes and glucose are typically monitored on the patient receiving TPN, so even if those things aren't mentioned, it doesn't mean they're not tracking them. I'm sure they must be checking Mg+ and prealbumin, too. I understand wanting to save this person unnecessary discomfort, and I'm all for vein preservation, but accurate lab results are also really important. You, or rather, the patient has to weigh the risks vs. benefits.

Ultimately, it's best to discuss this with the ordering physician. Maybe he can shed more light on this for you or figure out a plan that better fits the person's needs, like maybe a dual lumen port. Another consideration is how does this person feel about it all? Sounds like a talk with the patient and physician about the plan of care is in order!

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Specializes in -.

Thank you Stargazer...

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Inpatient/outpatient doesn't matter. I have outpatients that get their labs drawn off of ports.

As Stargazer touched on, the real point here is making sure you're working within your facility's policies. Some facilities will allow you to draw any kind of lab off a central line--and why not? As long as you've drawn off your waste amount and ensured that you've stopped the infusion for 5-10 minutes, a central line gives you direct access to central venous blood. It doesn't get much more prime.

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Labs should not be routinely drawn off ports. There are established protocols to follow. Read the evidence ( ebp??) regarding this. The more times a port is accessed, the higher the chances of getting infected. Central line assoc blood stream infections are serious. Hate to think a pt could get one because someone couldnt or didnt draw blood peripherally

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Specializes in Vascular Access.
Labs should not be routinely drawn off ports. There are established protocols to follow. Read the evidence ( ebp??) regarding this. The more times a port is accessed, the higher the chances of getting infected. Central line assoc blood stream infections are serious. Hate to think a pt could get one because someone couldnt or didnt draw blood peripherally

Yes, readtheevidence... I totally agree with you! The increased manipulation which includes blood drawing, has been shown to increase line infections. Many Infectious Disease docs write orders to stipulate that no labs should be drawn from the particular line that is in situ.

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Specializes in Infusion Nursing, Home Health Infusion.

It is really a risk versus benefit question and should be a patient specific decision. You can draw most labs from a CVAD of any kind if your technique is good but avoid coagulation studies from heparinised CVADs, Drug levels if that drug is being infused through the lumen

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