drawing blood from picc line

Forum topic

Wed, 06/23/2010 - 16:27

Drawing blood from arms with PICC lines

Can you draw blood in the arm that currently has a working PICC? I know the standard answer is, "Why not just draw it from the PICC". For the sake of the argument: is there documentation that says it is not appropriate to draw blood distally from a PICC line?

Thanks

Wed, 06/23/2010 - 18:45

At WoCoVA last week, there

At WoCoVA last week, there was some discussion about drawing blood samples from all types of CVCs with most speakers saying that it should not routinely be done due to the increased hub manipulation and it contribution to CRBSI. So I would only use any type of CVC for blood draws when there are specific reasons to avoid use of peripheral veins or there is a total lack of peripheral veins. When drawing from peripheral veins, here is the order of preference that I would follow:

1. draw from the arm opposite the PICC if possible.

2. draw from the ipsilateral side of the PICC in the hand, wrist or lower forearm distal to the PICC insertion site

3. the lower extremity would be the very last resort for drawing blood samples.

Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Wed, 06/23/2010 - 20:44

Blood draws for PICC lines

Blood draws are appropriate from PICC lines as long as sterility is maintained during the draw, hub manipulation is minimal, and proper flushing is done post draw. The biggest problems we see is proper flushing not done.

Sorry but I have to disagree

Sorry but I have to disagree as all evidence is pointing in the other direction. Needleless connectors are well documented to grow biofilm. Lack of appropriate cleaning and use of contaminated intermittent sets are producing this biofilm. Using any CVC for blood samping is just one more form of manipulation that can introduce organisms into the lumen. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Blood draws are painful!

While I see the importance of preventing infection, I also feel that patient comfort and nursing accountability need to be addressed with this issue. As a vascular access nurse, I have many patients tell me that nurses are not following the most basic infection prevention measures such as hand-washing and hub scrub. And patients are now being subjected to peripheral draws because of infection and poor flushing techniques. I feel like the education needs to catch up with the literature. I am very saddened as a nurse and a patient advocate with the idea that a vascular access device is unable to safely meet all of the needs of the consumer.

You raise many valid points,

You raise many valid points, but I also think we often "oversell" the VAD to our patients by promising them that they will do everything. The fact is that we simply can not promise this because there could be many reasons for not being successful with getting a sample - fibrin, thrombus, etc. Infection is just one risk, although it is taking precedence over all others right now. I have always thought that the VAD should only be used for blood sampling when there were no peripheral access, history of vasovagal reaction, etc. I have never thought that all VADs should be used for blood sampling on all patients. I think it should be a case-by-case decision. We simply do not have any research on the impact that blood sampling has on the life and functionality of the catheter. We have very little research on the sampling technique and their impact on accurate lab values, except for coagulation studies. There are several studies that have shown wrong coagulation values when drawn from heparinized catheters. There are other approaches in the literature such as point-of-care testing, and other ways that critical care nurses have found to reduce taking samples from VADs. One other concern is nosocomial blood loss and iatrogenic anemia because of frequent use of the VAD for sampling. So there are numerous issues to think about. lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Fri, 06/25/2010 - 23:26

We avoid PICC when possible

I fully agree,

PICC's were not developed for blood sampling in the first place. It i true that when using a PICC for blood drawn we increase the risk of CRBSI, possibility of contaminated blood sample leading to useless removal of the catheter, leading to placement of another PICC (with discomfort and possible delay in treatment) and mostly - in my institution anyways - increase in partial/complete occlusion, leading to usage of thrombolitic agents or removal of the catheter when unsuccessful, leading to another PICC placement (with discomfort and possible delay in treatment). There are many disadvantages to use PICC's for blood sampling. Right, patient comfort is an advantage to using them but there are numerous risks that must be taken into account especially if there are peripheral veins. More over, by using PICC's for blood sampling, bed side nurses are losing the dexterity to access peripheral veins which may come very handy when a patient is crashing without a PICC in place.

France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA

Mon, 07/12/2010 - 14:35

So I am understanding all of

So I am understanding all of you to say that it is not best practice to draw from the PICC line but to stick the patient anyway? I thought one of the purposes for putting picc's in was to assist with poor peripheral vasculature (inability to obtain PIV, inability to find a site for venipuncture, etc). We have been telling our patients this is one of the benefits of having a picc line......

Mally Harman, RN, BSN
Vascular Access Team Coordinator
Centra Health
Lynchburg, VA
434-200-2647

One of the problems is that

One of the problems is that we "overselll" CVCs to patients by telling them that they can be used for everything and they will no longer need to be stuck. This is false promises and one that is not always in the best interest of our patients. At the recent 5th Decennial Conference on Healthcare Associated Infections, a meeting of CDC, SHEA, APIC, and IDSA, there was heavy emphasis on hub and line manipulation increases the risk of introducing organisms that can lead to BSI. So decrease the number of times we open and/or use the CVC top as few as possible. We are all trying to reach Zero CRBSI now as these are seen as totally preventable infections. So many hospitals have limited blood draws from all CVCs to a patient specific decision. If there are no peripheral venipuncture sites, your only option would be the CVC. If there are available peripheral sites, they would be the first choice.

In addition to infection, there are also concerns about obtaining accurate lab values from a catheter drawn sample. The only studies pertain to coagulation lab values, which has all shown they you can not obtain accurate lab data from a catheter that has been exposed to heparin. Then there is the whole issue of nosocomial blood loss and iatrogenic anemia from repeated catheter drawn samples and wasting the initial sample drawn.

So this is a patient specific decision based on what is the least risk to the patient, but it should never be an automatic decision to use all CVCs for all blood samples in all patients. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Thu, 07/15/2010 - 15:45

#10

Blood Draw via PICC's.

We generally don't place a PICC UNLESS peripheral veins are not available. Of course if Vanco/TPN etc are needed and you have a 24ga peripheral, we will place a PICC, but then do you draw through the 24ga for blood?? Most small gauge peripherals are placed in a precarious location to begin with. Comfort of the patient HAS to be a consideration.

Do not allow a short PIV to

Do not allow a short PIV to dwell solely for the purpose of drawing blood samples. I agree that patient comfort is an issue but you have to weigh the risk vs benefits. A CRBSI from increased hub manipulation from drawing blood samples can cause lots of discomfort, plus increase the risk of death, etc. And dramatically increase the cost of care. Is that worth the price of peripheral sticks? I would totally agree that we need much more emphasis on venipuncture proficiency and stop the unnecessary sticks from staff that do not have adequate skills. I know that disease process causes many vessel changes, but I also strongly believe that many people have no peripheral veins left because of so many sticks of unskilled people. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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