South wales intravenous access advisory group guidelines for the care and maintenance of a peripherally inserted central catheter picc. A nurse is preparing to take a blood sample from a clients arterial line. To reduce clabsis, nurses need to address qualitycontrol issues and make. Just got an email from my shift coord saying my tpn pts labs came back critical.
For nursing students or new nurse grads who may not be familiar with central lines, they are most commonly placed in either the left or right internal jugular vein, but can also be placed in the. A chest xray is required to confirm placement, unless tip locator technology e. Adding a clabsi to your patients hospital list, isnt the best of ideas. Whats the proper way to draw blood from a picc line. Mayo medical laboratories interpretive hand book rochester, minnesota. Hard to find veins blood draw, ivs, venipuncture nursing, phlebotomy. The other day i flushed with 10 ccs of ns, then wasted 10, then drew blood. Central lines are ivs which allow medications to be given into large veins in the body, or to draw blood for lab work. Keep a list of your questions, problems, notes in a book or diary. Flush the picc line with a 10 to 20ml normal saline. Kathleen gaines phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career. Nurses may have to perform phlebotomy for their patient in various health care settings.
Or you could have some fibrin at the end of your line which may require it to be declotted. Blood samples may be collected through a picc or midline catheter. Guidelines for a certificate program in intravenous therapy for licensed practical nurses are available from the board of nursing office. Blood draw during the insertion of a piv catheter not direct venipuncture for blood draw has been associated with higher hemolysis rate. If the patient has intravascular lines in place that are 2448 hours, draw cultures and request a cab assessment as follows. Nursing points general candidates for drawing blood through the iv most ebp recommends against drawing through ivs candidates for this procedure are. This book is distributed under the terms of the creative commons. 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. Picc nurse insertionist, sault area hospital, sault ste. During the process of drawing blood, the client complains of severe pain in the extremity and the nurse stops the process. However, many institutions have dedicated teams of picc nurses. Doug ducey joey ridenour arizona state board of nursing. Remove the first 3 to 5 ml of blood and then discard.
Picc lines are longer and smaller than other cvad therefore. Forgot to stop tpn before drawing blood from central line. Must have specific md order to draw blood from picc. Picc line blood draw explained e phlebotomy training. Reduce the risk of air inadvertently entering the line. Hostos nursing students picc line dressing change facebook. Picc line peripherally inserted catheter changing existing iv fluids medicated and. You often need blood transfusions or blood drawn for tests.
Catheters without valves will always require a clamp to prevent blood reflux or air entry into the lumens. I realized i forgot to stop the tpn before drawing from the line. Nclex transfusions blood, parenteral, central lines. Iv nurses society standards the intravenous nurses societys standards do not support the practice of drawing blood specimens from peripheral iv lines. The patient was from a local skilled nursing facility and was being treated for an infection. Fluids infuse slower they occlude faster infusing drawing blood may be difficult with small gauge lower rates of infection. A lthough the incidence of central lineassociated bloodstream infections clabsis has decreased, the centers for disease control and prevention reports that an estimated 30,100 of these infections still occur in the united states each year, resulting in thousands of deaths and adding up to billions in costs. The cdc specified that picc blood draw procedure should be as follows. Percutaneous central catheter picc statpearls ncbi bookshelf. The biggest problems we see is proper flushing not done. If you need to have blood transfusions often, you may need a picc or midline.
When we look at best practice, we know that we should not use central lines that do not produce a blood return. Caring for a peripherally inserted central catheter or. No blood return from the picc line cvc health care. When leaving hss, the patient is provided with an information book, phone. The nurse called and stated they were unable to get a blood return from the line. It is west virginia state law that nursing students lpn and rn are forbidden to start ivs or draw blood samples on patients. Flushing and taking blood from a picc line youtube.
Access the catheter as outlined above, maintaining aseptic technique. 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. Policy and procedure flushing and or blood withdrawal. Sure enough, neither port, medication nor blood, gave me a return, but flushed well and fluids ran perfectly well into the line. Using vacutaners with picc lines for blood draws we were having a debate at work today about using vacutaners to collect blood for lab draws from a picc.
Each set of blood cultures consists of one anaerobic and one aerobic bottle. A long iv line usually placed into your childs arm. Flush immediately postinfusion and after blood drawing. April 2014 south wales iv access advisory group picc guidelines. The cephalic vein is another option for piccline placement but, in addition to. Maintain aseptic technique when accessing the catheter as outlined. 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. Flushing a central line requires saline flushes and alcohol pads. Discontinue a central venous line this includes a peripherally inserted central catheter.
The patient let me know that the nurses the last few days have not gotten a return, so lab has been drawing his blood the last few days. The placement of a picc line may only be carried out in settings where the equipment and expertise of other health professionals to manage complications are readily available. Remove and discard the used syringe and attach a new syringe to draw. Instead they give the following process as the one to follow when drawing blood from a picc line cdc, 2011. Keeping the syringe attached to the catheter hub, push to reinfuse the blood into the catheter. Picc line flushes but no blood return private care. How to draw blood from a picc line general nursing. If drawing blood from a peripherally inserted central catheter picc line or central line, you will need an alcohol pad or appropriate cleansing agent for the port, a tube holder, a needleless vacuum collection device, appropriate blood tubes including a waste tube, patient labels and saline flushes for each port.
Stroke end of life symptoms a stroke is a medical condition in which poor blood flow to the brain results in cell death. This includes routine flushes with the completion of. But the lab called to say that the results looked wrong extremely low hemoglobin level and that the blood probably had saline in it. Central lines, aka cvads inflexible, approximately 10 inches long, dwell time 710. As for not being able to aspirate blood from a picc, it could be a pressure issue from not using the right size syringeyou should never use a vacutainer to draw blood off a picc.
Central line insertion and how to draw blood from new to icu. The function of the vad including presence of blood return, amount of blood draw and infusion solution. The correct order of draw for blood collection tubes must be adhered to, to prevent. Using the same syringe, pull to aspirate 6 ml of blood into the syringe. Its also not very easy to flush all the precipitate out of the max plus caps. Repeat the aspiration and reinfusion at least three times. Thanks to my nurse michelle who is doing the talking as she does it. Peripherally inserted central catheters picc line insertion and removal by registered nurses. How to draw blood from a picc line nurses experience. When drawing a blood sample from a central line, be sure to use good hand hygiene to avoid causing a central line associated bloodstream infection clabsi. Unused lumens of multilumen piccs may be heplocked in certain. I told the nurses i would post a question here and see what expert advice i could get. The texas nursing practice act and the boards rules and regulations define the legal scope of practice for licensed vocational nurses lvns.
Raiselower the hob etc, but if all fails, then obtain an order for. Reducing the risk of central lineassociated bloodstream. For additional copies of this book, please visit patient and family education. Collect one set of blood cultures from a peripheral stab and from each indwelling line arterial, central line, picc. I didnt see in the book they gave me about drawing blood so i got scared. This may be done instead of having a caregiver draw blood using a needle poked into your vein. Indications picc lines are suitable for many situations when access is limited or expected to last longer than 2 weeks and also allows for easy blood draws where appropriate. Using vacutaners with picc lines for blood draws iv.
A 2009 study by halm and gleaves showed the hemolysis rates of samples obtained from new piv is 12. To obtain blood samples for laboratory evaluation, eliminating the need for peripheral vein puncture to verify venous placement prior to administration of hypertonic or vesicant solutions. Parentguardian may read a story book to child with the clinical. If the gauze becomes soaked with blood, a nurse should be told to change the dressing. When your central line wont flush if you are an icu nurse, then you are familiar with central venous catheters, or central lines. Depending on the line, the doctor may want your line to get heparin, an anticoagulant, to prevent the line from clotting off. Policy and procedure flushing and or blood withdrawal aspiration procedure for picc line and midline catheters purpose. Peripherally inserted central catheter picc uc davis health. Difficult access patient noncompliance those getting a freshly iv placed only draw through an iv when necessary prior. Since every lumen of the patients iv catheter must yield a blood return, i too would employ nursing interventions first. 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. If drawing blood from a peripherally inserted central catheter picc line or. Shows how to withdraw blood and then replace old red cap with new pair of maxplus caps on a picc line.
The lvn scope of practice is a directed scope of practice and requires appropriate supervision of a registered nurse, advanced practice registered nurse, physician assistant, physician, dentist. 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. Is it appropriate to draw blood for lab work from picc lines. South wales intravenous access advisory group guidelines. Practice licensed vocational nurse scope of practice. Texas board of nursing practice licensed vocational. Routine flushes with saline or heparinized saline, including peripherally inserted central catheters picc and central lines. How to find a vein when starting ivs or drawing blood tips in the arm duration. Ive heard that drawing blood through the endcaps can cause hemolysis. As a student, you are only permitted to discontinue ivs per physician orders under the supervision of your clinical instructor. Our policy for blood draws from a picc was to stop any ivf infusing, flush the lines with 10cc of saline, withdraw a waste, withdraw the sample, then flush with 20cc of saline before starting the fluids again. A flash or sluggish return is not acceptable and requires further assessment. Picc lines are typically chosen when longer lengths of intravenous therapy are needed but both picc lines because a picc lies within this large vessel, a blood return should be swift and substantial. So ive been instructing staff to remove the caps and draw directly from the hubs, replacing a new cap afterward.
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