Stop TPN when drawing blood from PICC?

mamiekay · Feb 17, 2010

We were taught to stop everything before drawing from a PICC, or any line. Stop whatever's running, then flush the lumen you're going to draw. If I'm just drawing a blood count, I flush once. Any time I'm drawing levels--BMP/CMP, heparin levels--based on what's been running, I flush twice just to make sure the sample is clean. I've seen too many other nurses flush once, waste, then draw & have their results come back critically high, so then they have to redraw to verify or negate the first results. Our hospital protocol is to turn off all fluids, flush with 10cc NS, draw 5cc blood to waste, draw blood for labs, flush with 20cc NS, then restart any fluids. Here's my routine:

mamiekay · Feb 17, 2010

Sorry, my computer's acting up this morning. My last message posted before I was finished. Anyway, here's my routine: turn off fluids, lay out on the bedside tray all of the supplies I've gathered, flush with 20cc NS the lumen from which I'm going to draw, let sit for a minute, then draw 5-7cc blood to waste, draw enough blood for all the labs, then flush lumen with another 20cc NS & restart the fluids. In two years, I've only had to redraw one time and that was because the patient was a hard, slow draw & the blood coagulated in the tube by the time it got to lab. IMHO, it save my time if I just take that extra step the first time than having to go back & redo everything. And it saves the hospital money. One extra 10cc NS flush the first time v. the whole get-up twice.

As for the statlock & dressing, only our IV team touches those so I don't know what to tell you. Check your hospital/unit policy & protocols & ask your charge. Good luck!

iluvivt, BSN, RN · Feb 19, 2010

Yes you have to stop ALL infusions.....a one full minute shut OFF is ALL you need.....15 min is way too long and your line can clot off....with all the blood dumping into the SCV..it is plenty...and yes I have checked on this multiple times.......make sure you have all your supplies ready to go.......scrub cap well. verify patency with an NS flush if you desire..perform your discard..I usually do about 5-6 ms on a PICC.......set the discard in a place where you will not accidentally use it as the sample...draw your sample with a syringe...transfer to tubes and immediately flush with NS...I usually double my NS after any blood draw using a nice pulsatile flush,,,resume IVFs... A lot of hospitals have done away with a dressing change 24 hrs after PICC insertion..on a good majority of our pts we hold pressure and then apply the Biopatch and TSM...if pt is still oozing we still apply the Biopatch...but add some gauze..then the TSM and change that in 48 hrs....if any gauze under dressing it should never stay on past 48 hrs...If your policy says to change it at 24 hrs...then you most likely will need to change the stat loc and biopatch at that time....that is if you have a 7 day dressing by the time you change it again the stat loc and biopatch will actually be 8 days old....the stat loc should only stay on a max of 7 dressing as well as the biopatch...what you could do if you can keep them both on ( I find that a bit difficult)...then you need to change that dressing 6 days from that first dressing change...the same things would apply to the caps if your policy says change those every 7 days....it becomes a bit confusing...so I just change everything...you can not be to careful with these lines and your infection prevention strategies

LiliaBSN · Feb 25, 2010

I was taught that you can shut it off for a minute or two, draw a waste and then get your sample. But yes, TPN has to be off. As far as the whole dressing change thing, it depends on where the statlock is. If it is underneath the clearsite dressing, then yeah, you have to change it and the bio patch. Because if you don't then you are just putting a nice clean sterile dressing on top of a dirty statlock. It can't hurt to change it, especially since they aren't that expensive.

Tinabelle · Feb 26, 2010

:) Thank you!

iluvivt, BSN, RN · Feb 27, 2010

just remember the stat loc can only stay in place for a max of 7 days...the best practice is to change everything...it is very difficult to pull off a TSM dressing and keep the biopatch intact...yes sometimes it will not not tear the edge off the stat loc...but the goal is to remove everything so you can clean the skin...an extrinsic source of catheter related blood stream infection. Think of it this way...we use maximum barrier precautions to place the PICC...mask, gown, gloves and a full body drape covering pt from head to toe....now after all that we need to perform the dressing change and cap change and general care with the same due respect...the latest products and research will be working on preventing intrinsic sources of infection as those that enter the system frm the cap and connections into the system