A peripherally inserted central catheter line is known as picc line. Using pushpause flushing method, slowly flush saline into the catheter. Dec 29, 2007 hi there, and picc lines, oh i just love them and central lines and ports. I didnt know you could hook a vacutainer directly to a picc line. When i was a paramedic we would obtain one red top tube if we felt the medical emergency was th. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. The picc should not be used until they can get a blood return. Feb 05, 2015 if slow and gentle does not produce a blood return, change to a smaller syringe. An introduction to your childs peripherally inserted central catheter picc why does my child need a picc. A picc is a peripherally inserted central catheter. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Peripherally inserted central catheters are also called picc lines or central. We draw from piccs all the time, you just cant use a syringe bigger than 3cc. Attach collecting syringe, unclamp and withdraw the amount of blood necessary for lab.
At my facility, you use a 10cc syringe and you have to waste the 1st 10cc syringe unless youre drawing blood for blood cultures. The nurse informed the lab tech that only a 10ml syringe could be used for central lines. This chapter covers all the steps recommended for safe phlebotomy and reiterates the accepted principles for blood drawing and blood collection 31. Each morning, during flush we always check for blood return. Excessive force could cause a flexible picc to temporarily collapse and occlude the backflow of blood. Drawing blood from picc lines page 5 patient safety issues. Picc syringe or greater 3 ml nicu even if the amount of.
Every pt with a picc has an order to never use anything. For patients with severely compromised venous access, though, the picc may be the only option for drawing blood specimens. Difficulty in drawing blood from the catheter may be due to patients position, occlusion of the catheter. Needles used for blood drawing have long been rec, used for venous blood drawing. Reattach prior tubing to line if applicable and restart iv drips. Dear george fritsma, i work at the valley hospital in ridgewood n. Obtaining blood specimens from a central venous catheter. Discard blood filled syringe in punctureproof container. Purpose this guideline has been developed as part of the icare intervention bundle for the management of intravascular devices ivds. Use 10 ml syringe and withdraw 5 ml of blood and discard appropriately in biohazard container 9.
It is a flexible plastic tube that can be attached to a syringe or a drip that contains your medication. An introduction to your childs peripherally inserted central. Is there a protocol of how long to stop the infusion. This may be done instead of having a caregiver draw blood using a needle poked into your vein. Peripherally inserted central catheter picc line mayo clinic. How to collect blood from a central line vacutainer method. Central and picc line dressing blood extraction duration. Our facility uses the stopcock method to draw blood from a picc. They can show you the technique for heplocking your line that is best suited for your device. Use a pulsatile flush and positive end pressure unless groshangs valve. How to draw blood from a picc line nurses experience.
Is it appropriate to draw blood for lab work from picc lines. A 2009 study by halm and gleaves showed the hemolysis rates of samples obtained from new piv is 12. Peripherally inserted central venous catheters picc. It is suitable for long term use and there are no restrictions for age, or gender. As with all central lines, 10 mls is the minimum size syringe to be used to flush a picc line. My infusion line worked great, however my other line has no blood return. If unable to obtain a blood waste, may use a sterile 12ml syringe or a vacutainer transfer set. South wales intravenous access advisory group guidelines. How does this work do you use the vacutainer transfer device to do it. Please visit my if no blood return after troubleshooting, you may be able to depending on your company, procedures, etc be able to get a doctors orders for cathflo which is a small dose of tpa you instill into the picc line to. Using picc lines to draw blood is a common practice in the medical unit.
Drawing blood from picc lines patient safety issues allnurses. I have 2 lumens, one for iv hydration and 1 just in case need for tpn. Flushing and blood withdrawal from a central line youtube. This article discusses potential complications catheter occlusion, bleeding and hematoma, catheter tip migration, catheter rupture, phlebitis and associated pain, swelling and deep vein thrombosis dvt, infection, and embolism. Who library cataloguinginpublication data who guidelines on drawing blood.
Start studying chp8 techniques for initiation and maintenance of central vascular access. The end of the picc ends in a vein close to the heart but not in the heart. Using smaller syringe size can result in excessive pressure being exerted which could result in a damaged catheter. If drawing blood, discard the first 510 ml, unless children give back blood, flush with 10 ml ns after blood draw or heparin. Place the empty syringe into the needle free connector at the end of the picc and pull on the plunger to withdraw blood into the syringe. Caring for a peripherally inserted central catheter or. Collect blood samples to prevent dilution or contamination with iv fluids or vaccum tube contents. It doesnt occur with peripherally inserted central catheters piccs. Peripherally inserted central catheter picc line access page 1 of 4west. Use 10 ml syringe to withdraw required amount of blood for laboratory test. May 11, 2012 i was just consulted this past week to assess a picc line in the er when a patient presented with a line that did not draw blood. Jan 09, 2014 order of draw and additives blood collection duration.
If your picc line is filling with blood on a regular basis after you heplock it, you might consult your nursing service. Picc line and syringe driver questions hi all, bloods can be taken from picc lines. If resistance is felt with flush, see infusion therapy central venous catheter. Trouble getting a blood return lynn hadaway associates. Remind caregivers not to check your blood pressure or give needles in the. This video has been jointly created by interventional radiology, fluoroscopy and cardiology services and. A broviac is a type of central line that allows for longterm access to blood. Best practices in phlebotomy who guidelines on drawing. Guidelines for the care and maintenance of a peripherally. It is intended to teach the principles of line care, but not intended to be an instructional video.
Flush the picc line with a 10 to 20ml normal saline. How to draw blood from a picc line general nursing. If blood aspirates freely, remove the 10 ml syringe with blood and discard. A picc line peripherally inserted central catheter line is used to give someone chemotherapy treatment or other medicines. Risks associated with drawing blood specimens from a picc include infection and catheter occlusion or rupture if the picc isnt flushed properly afterward. The positive pressure end cap must be changed after every blood draw on both piccs and other central lines. Scrub catheter cap with alcohol and allow to air dry 8. Shut off intravenous iv fluids infusing through line and clamp lumen. Lock the prefilled normal saline syringe to the port using a luer adaptor. In healthcare, this procedure is performed by medical laboratory scientists, medical practitioners, some emts, paramedics, phlebotomists, dialysis technicians, and other nursing staff. When drawing blood for blood culture syringe method will be used. Attach your empty syringe s and draw back your blood samples. If necessary, clamp the catheter when flushing is complete. Central lines are used to give fluids, medications, blood products, nutrition and to draw blood for labs.
You have a peripherally inserted central catheter picc. Chp8 techniques for initiation and maintenance of central. To promote positive outcomes, clinicians caring for patients with central lines must monitor carefully for signs and symptoms of complications. Although the safest and most accurate way to draw blood for lab work is via peripheral veins, you may need to draw blood through a central venous catheter cvc if the patients peripheral veins are no longer accessible. The other day i flushed with 10 ccs of ns, then wasted 10, then drew blood. Use the initial specimen of blood obtained from the catheter for the blood cultures. With the flush still attached, draw back and get your waste 10 ml. When drawing blood from an indwelling line, the inrptt should be drawn after blood gases to prevent contamination of the ptt from the heparinized blood gas syringe. A central venous access device inserted into a peripheral vein whose tip dwells in the superior vena cava and is used in acute care, long term care or home care. Picc and midline flushing sodium chloride 5cc before and after routine ivmedications 10cc ns before and after blood draws picc only10cc sodium chloride ba tpn 20cc ns after blood product administration heparin 100 unitscc 2. Its generally not done after an iv has been established and has run for some time. On a peripheral vein, you could be pulling the vein wall over the catheter lumen as in this drawing. Withdraw maximum of 3 ml blood normal saline mixture the internal lumen of a 20gauge picc catheter is 0. Check your protocol but using 3cc syringe is a big no no.
Broviac care central lines a central line is a catheter, or soft flexible tube, that is placed into a large blood vessel near the center of the body. To decrease the number of times your child is poked with a needle to administer medications and fluids into a large vein to draw most blood samples what is a picc line. Or should that only be done at the time of insertion. Drawing blood from a picc line general nursing allnurses. Ins recommends using a 10 ml or larger syringe for flushing especially with picc. How nurses flush a picc line peripherally inserted central catheter duration. Pull back plunger and withdraw 5 ml of blood for discard. If using a picc line, you may also ask the resident to straighten hisher arm. And when filling the syringe, pulling back too hard will cause the blood vessel wall to suck up against the needle bevel and stop the flow, so you pull back gently. This special iv is placed into a large vein in the upper arm and sometimes in the leg of an infant.
If slow and gentle does not produce a blood return, change to a smaller syringe. Picc line blood draw explained e phlebotomy training. Central venous catheters picc, short term, tunneled, i. Infusion therapy peripherally inserted central catheter picc. You should not be drawing blood through picc lines if the doctor ordering the. Be sure to ask them how to ensure a slightly turbulent flow, safely. This line is used to give treatments like chemotherapy, antibiotics, blood transfusion, liquid fluid, and iv intravenous fluids.
Discard appropriate amount of blood when collecting from an indwelling line vad. If done properly, you can definitely draw from a picc line unless its against policy of course. Central line insertion and how to draw blood from new to icu. Picc line flushes but no blood return private care. The chapter includes background information section 2.
Before obtaining a sample, the picc or port should be flushed. Peripherally inserted central catheter picc maintenance and management of potential complications section. Blood draw during the insertion of a piv catheter not direct venipuncture for blood draw has been associated with higher hemolysis rate. The lab tech disagreed and stated it didnt matter what size the syringe was when drawing labs. The stepbystep guide to professionally drawing blood.
Central venous catheter care and maintenance guideline draft heparin use requires a physicians order central venous catheter page 5 of 7 catheters catheter flushing dressing reflux valve cap blood withdrawal needed to clear line nicu. To facilitate blood return, gently reposition the resident to a sitting or lying down position, or ask himher to cough. When drawing blood for multiple tube collections, it is important to take into consideration proper venipuncture technique and correct order of draw. If drawing blood, discard the first 510 ml, unless children give back blood, flush with 10 ml ns after blood draw. Other sources that outline blood draw from picc line provide a similar process but more extensive and specific. This video has been made to demonstrate proper flushing and blood withdrawal from a central line. Aspirate first to determine picc patency, then flush with 510 ml of normal saline before drawing any blood. A risky use of injection equipment by janine jagger, m. Obtain a needleless blood transfer device to draw blood.
A picc line is a long, thin, hollow, flexible tube called a catheter. Disinfect top of blood culture bottles with an alcohol pad. Follow your facilitys policy for obtaining blood specimens. Peripherally inserted central catheters piccs page 3 of 12 acute care pediatrics needleless adapter applied to all iv infusions home care clients only. There is no need to withdraw blood into the syringe prior to a routine flush with saline rcn. I dont think blood can be taken from a picc line though. I know that you cant use anything smaller than a 10cc to inject into a picc line but is there anything out there about using a smaller 3cc syringe to draw off a picc line. Whats the proper way to draw blood from a picc line. In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of intravenous therapy or for blood sampling of venous blood. You need to rinse out the catheter after every use. Caring for a peripherally inserted central catheter or midline. Peripherally inserted central catheter picc a peripherally inserted central catheter picc is a small gauge catheter that is inserted peripherally but the tip sits in the central venous circulation in the lower of the superior vena cava.
The health care provider will then confirm that he or she can draw blood through your picc or port by taking a small sample and discarding it. Helpful tips when drawing blood all central lines can be used to draw blood. May 20, 2012 normally you would put a little air in the syringe to start with and that allows the blood to flash back into the syringe without needing to draw back. For a central vad, changing the patients position could help if the catheter is against the vein wall. After about 34 months mine stopped being able to draw.
When drawing blood from a doublelumen central venous catheter, the proximal port is used because it is usually the port with the largest lumen. Taking these factors seriously can lessen discomfort and complications for your patient, lessen procedure time, and prevent errors in diagnosis caused by cross contamination of additives between blood collection tubes. When caring for a central line, make sure all air is removed from syringes, all syringes. This guideline provides recommendations regarding best practice for the use and management of invasive devices based on current. When using a picc line, at least a 4 fr size is recommended. After a discussion with the lab manager, she requested evidence to support using only a 10ml syringe or larger for aspirating blood from cvcs. Trouble getting a blood return hadaway associates blog lynn.
The down side with my picc line was it burst and fluid leaked into my arm. Venous blood drawing is a show that drawing venous blood. Collecting heparin assay specimens from a device the. Hard to find veins blood draw, ivs, venipuncture nursing, phlebotomy duration. There is medication that can clear the line safely and prevent a blood clot from forming. For blood cultures, the initial specimen is used for the sample, and the line is not flushed beforehand. Using a 5 ml or 3 ml syringe on aspiration will generate less force and could produce a blood return when a 10 ml syringe will not. Mar 28, 20 no this is not normal and you are at high risk for another blood clot in this line. Stop all infusing fluids for at least 1 minute before drawing a specimen 7. It helps carry nutrients or medicine into your body. Clogged caps should not occur if staff use correct technique for infusions and blood draws.
Venous blood collection order of draw interior health. Central lines are ivs which allow medications to be given into large veins in the body, or to draw blood for lab work. Nov 11, 2016 its generally not done after an iv has been established and has run for some time. Make sure to follow your hospitals policy when drawing blood. Heparin requires an independent double check prior to use.
How to flush a picc line peripherally inserted central catheter duration. If collecting a blood culture that requires isolator microbial system afb or fungus, prep stopper with alcohol. Amateur drawing blood with needle creative writing forums. Your doctor might recommend a picc line if your treatment plan requires frequent needle sticks for medicine or blood draws. One thing to keep in mind is that on some picc lines you should only use a 10 cc syringe to draw back withhas to do with the pressure exerted on the line. Discard syringe with blood into punctureproof container. Using vacutaners with picc lines for blood draws iv. Procedure as i was taught, flush your red line with ns 5 ml, then aspirate 510 mls then discard. Shows how to withdraw blood and then replace old red cap with new pair of maxplus caps on a picc line.
Trouble getting a blood return lynn hadaway associates, inc. Determine if blood return is hampered by the position of the patients arm or. How to find a vein when starting ivs or drawing blood tips in the arm. Yes, a nurse can draw blood from an existing peripheral iv and at the time of insertion. Bear in mind that when you do so, you increase the risk of cvcrelated complications, such as occlusion and infection.
When drawing blood from a double lumen picc line, which has tpn running do you 1 flush with 10mls of normal saline, pull back 10mls of blood discard and throw that away before taking your sample. At my facility, you use a 10cc syringe and you have to waste the 1st 10cc syringe unless youre drawing blood for blood. The line was placed inhouse 5 days prior, placement was verified by ecg in the cavoatrial junction and later confirmed by a nonrelated cxr prior to discharge. No blood return from the picc line cvc health care. The hospital where i work has no policy on this topic and i learned in nursing school that drawing blood from a picc line was not appropriate because of the increased risk of developing blood clots. Too vigorous drawing with syringe too forcibly putting blood into tube via syringe the combination use of an iv catheter and vacutainer caused increased hemolysis compared to the use of an iv catheter and syringe in one study. Picc and midline catheters carle illinois college of.
It is put into one of the large veins of the arm, above the bend of the elbow. Can a nurse ever draw blood from a piv after it has been in situ. The antt key parts to consider when taking blood from a picc are. Blood is drawn into the syringe from the picc, then turn the stopcock off to the picc and the blood drawn into the tubevacutainer from the syringe. With a picc, the healthcare provider will attach a clean syringe to your catheter and draw up the sample.
If blood return cannot be obtained from a central venous line, refer to the central venous line occlusion management and declotting procedure cen05. Picc line and syringe driver questions cancer council. If the blood does not come out, flush with a small amount of saline and try again. But drawing blood during the initial set up is done all the time. It is also used to take blood when you need to have blood tests. I had been taught that drawing off a line with a smaller syringe could cause the line to collapse. How to access a picc for intravenous fluids or drugs please use strict aseptic technique. How to access a picc for intravenous fluids or drugs. Flush immediately postinfusion and after blood drawing. Quick question for those with picc line experience. Care guide for caring for a peripherally inserted central catheter or midline catheter. But the lab called to say that the results looked wrong extremely low hemoglobin level and that the blood probably had saline in it. Presented by shows how to withdraw blood and then replace old red cap with new pair of maxplus caps on a picc line.556 1539 573 735 185 288 755 533 806 1322 984 1013 1458 139 553 759 1287 326 108 1675 883 63 725 1454 1259 91 1214 1154