This led to compromised patient care by delaying drug administration and blood sampling whilst alternative intravenous access was obtained. When your central line wont flush if you are an icu nurse, then you are familiar with central venous catheters, or central lines. How to draw blood from a picc line general nursing. Using vacutaners with picc lines for blood draws iv. No blood return from the picc line cvc health care. Shows how to withdraw blood and then replace old red cap with new pair of maxplus caps on a picc line. Valved catheters prevent backflow of blood into the catheter when the system is open. The advantages and disadvantages of peripherally inserted central venous catheters picc in relation to other types of central venous catheter are discussed, and the principles of use and practical applications of ultrasound for venipuncture are explained. Using pushpause flushing method, slowly flush saline into the catheter. It usually is placed at the bend of the arm near the elbow or close to it because this vein has a large volume of blood flow. Accessremove a noncoring needle from an implanted subcutaneous port. It also has general guidelines for caring for your picc at home. Evidencebased practice ebp guideline drawing labs from. Guideline peripherally inserted central venous catheters picc 1.
Prime tubing and adapters prior to attaching to picc line. See more ideas about iv therapy, nursing students and nursing notes. A nurse is preparing to draw blood from a patients central line using the syringe method. Guideline for peripherally inserted central venous catheters picc. Peripherally inserted central venous catheters picc. Is it appropriate to draw blood for lab work from picc lines. Open the 10ml syringe and place it onto the end of the picc and withdraw 3 mls of blood from the.
Learn about why its done and potential picc line complications. Lock the prefilled normal saline syringe to the port using a luer adaptor. Picc or peripherally inserted central catheter is used for intravenous access in the medium to longterm. Thanks to my nurse michelle who is doing the talking as she does it.
Collect one set of blood cultures from a peripheral stab and from each indwelling line arterial, central line, picc. Remove the first 3 to 5 ml of blood and then discard. One of the things you will encounter as a nurse is a picc line also called a peripherally inserted central catheter. South wales intravenous access advisory group guidelines.
Aspirate blood from central lines for patients 12 years and older according to standards of nursing practice and lab requirements. 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. It is about 18 24 inches long and goes into the large vein near your heart. However, many institutions have dedicated teams of picc nurses. Purpose this guideline has been developed as part of the icare intervention bundle for the management of intravascular devices ivds. It is west virginia state law that nursing students lpn and rn are forbidden to start ivs or draw blood samples on patients. Draw up 10 cc normal saline in syringe and set aside 0. Also, prior to drawing back blood from the picc line infuse 10cc of normal saline and then draw off a waste. Just got an email from my shift coord saying my tpn pts labs came back critical. Oct 06, 2009 picc lines are commonly used for intravenous therapies that will take a long time.
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. Developed in alignment with ins infusion therapy standards of practice, fit is a valuable tool for students and practitioners at all levels of the infusion nursing specialty. Nov 15, 2019 peripherally inserted central catheter picc. An intravenous line attached to the picc is also shown.
It is important not to get any air into your picc line. Central venous catheters picc, short term, tunneled, i. If a physician orders a single blood culture, the nurse is authorized to obtain a second set. Each set of blood cultures consists of one anaerobic and one aerobic bottle. Picc line care picc line dressing change clinical nursing.
Picc line insertion can be done by a nurse, doctor or other trained medical provider. Understanding your peripherally inserted central catheter picc. Percutaneous central catheter picc statpearls ncbi bookshelf. The promise of novel technology for the prevention of intravascular. This may be done instead of having a caregiver draw blood using a needle poked into your vein. Picc lines are longer and smaller than other cvad therefore. Air bubbles may enter the blood vessel during insertion of a picc and with its use. But as simple as it sounds, there are several factors to consider. Some lines have caps at the end that stop air from getting into the line. 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. Manufacturers specific recommendations should be noted and adhered to by individual practitioners. Kathleen gaines phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career.
Central venous catheters care of peripherally inserted central catheters piccs accessing dressing changes tubing and adapter changes. Flush immediately postinfusion and after blood drawing. This book is distributed under the terms of the creative commons. However, my didactic instructor says this is not best practice and is unnecessary. The picc is put into a large vein by a certified nurse or doctor. Methods and techniques used during central venous catheter insertion and management are critically important to preventing catheterassociated blood stream infections or central line associated bacteraemia. Picc line blood draw explained e phlebotomy training. The cephalic vein is another option for piccline placement but, in addition to.
Heres a link for picc lines we use at my facilitythey have nursing info. The picc, also called a picc line, is used for giving iv fluids, iv nutrition fluid also known as tpn and medicines, and for drawing blood. Serious risks from common iv devices mean doctors should. Forgot to stop tpn before drawing blood from central line. Depending on the line, the doctor may want your line to get heparin, an anticoagulant, to prevent the line from clotting off. Historically community hospitals trained nurses to insert picc lines in addition to maintaining daily responsibilities.
During the process of drawing blood, the client complains of severe pain in the extremity and the nurse stops the process. Patient care plan for the care of peripherally inserted. 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. Care must be taken not to dislodge the catheter when attending dressing changes and removing any securement devices and accessories. Peripherally inserted central catheter picc childrens. The centers for disease control and prevention cdc does not state that it is inappropriate to draw blood from a picc line. Guidelines for a certificate program in intravenous therapy for licensed practical nurses are available from the board of nursing office. How to draw blood from a picc line nurses experience.
A nurse is preparing to draw blood from a patients central. Registered users can save articles, searches, and manage email alerts. 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. The larger veins in your chest carry more blood, so the medicines are diluted much. 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. As a student, you are only permitted to discontinue ivs per physician orders under the supervision of your clinical instructor. I didnt see in the book they gave me about drawing blood so i got scared. Lines, tubes, ports, what to do with them tony melendez version 20. Yes, provided that you pause the infusion of heparin prior to taking your lab sample.
What other situations would require that the nurse stop blood sampling from an arterial line. May 24, 2017 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. Flushing and blood withdrawal from a central line youtube. I told the nurses i would post a question here and see what expert advice i could get. Any documents appearing in paper form are not controlled and should be checked against the electronic file version prior to use. The program features 8 learning modules that take the participant, step by step, through the essential elements of infusion therapy. Written by jennifer gretzema, llpc, ma, ccls, the book reassures kids about peripherally inserted central catheters and helps them understand more about their medical condition and treatment procedures. Active learning templates therapeutic procedure a therapeutic procedure active learning template.
Lpn scope of practicepicc linesjust moved to indiana page. 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. May 11, 2012 one of the nursing interventions in obtaining a blood return could be attempts at flushing, however, my first intervention would be to attempt to aspirate first when i hook up a syringe, if i dont readily get a blood return then my nrsg interventions are employed. Risks associated with drawing blood specimens from a picc include. We observed a high 5 out of 7 lines, 70% rate of picc blockages on the trauma and orthopaedics ward over a two month period. There are there is usually one, two, or three lumens iv.
This definition includes the insertion and removal of peripherally inserted central catheters p1cc lines or devices upon order of a licensed physician, physician assistant, or nurse practitioner. Check out these bestsellers and special offers on books and. Groshong, groshong n xt picc and midline perqcath, poly perqcath picc and midline blood withdrawal needle to needless adapter through injection cap vacuum blood collection system or syringe 1. Discontinue a central venous line this includes a peripherally inserted central catheter. Turn head and cough, the pt should try that, not you lol reposition the patient ie. It helps children learn why chris has a picc line, what it does, how it works and how chris got it. Access the catheter as outlined above, maintaining aseptic technique. Understanding your peripherally inserted central catheter picc what is a picc line. If drawing blood from a peripherally inserted central catheter picc line or.
Description of procedure indications outcomesevaluation considerations nursing interventions pre, intra, post potential complications client education nursing interventions josh lourdon removing a picc line ch 27 i actually had to use a nursing website for this one dt the book not having. Maintain aseptic technique when accessing the catheter as outlined. This information explains what a peripherally inserted central catheter picc is and how its placed. Nursing points general candidates for drawing blood through the iv most ebp recommends against drawing through ivs candidates for this procedure are. If the patient has intravascular lines in place that are 2448 hours, draw cultures and request a cab assessment as follows. To reduce clabsis, nurses need to address qualitycontrol issues and make. 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. Jun 30, 2004 krissee, i work at 2 different hospitals in indiana. Unused lumens of multilumen piccs may be heplocked in certain. While not commonly taught in nursing school, programs recommend nursing students take extra courses to hone this skill. Inserting, repairing, or removing arterial and central venous catheters, including picc lines.
A picc line is a thin, flexible, hollow tube placed in a vein in your arm, usually above the elbow. When we look at best practice, we know that we should not use central lines that do not produce a blood return. If you are drawing blood off an existing iv line, you will need an alcohol pad or appropriate cleansing agent for the port, a tube holder, a tourniquet, a needleless vacuum collection device, appropriate blood tubes, patient labels and a saline flush. Fluids infuse slower they occlude faster infusing drawing blood may be difficult with small gauge lower rates of infection.
Aug 31, 2017 adding a clabsi to your patients hospital list, isnt the best of ideas. Flushing a central line requires saline flushes and alcohol pads. 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. In most hospitals, picc lines are inserted when therapy is anticipated to last more than 7 days especially with corrosive medications or fluids. Use 10 ml syringe and withdraw 5 ml of blood and discard appropriately in biohazard container 9. Must have specific md order to draw blood from picc. 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. Generally, picc lines are not sutured and are heldin place by the non suturing securement device, the dressing, and any steristrips if used. If necessary, clamp the catheter when flushing is complete. Reducing the risk of central lineassociated bloodstream. 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. The nurse called and stated they were unable to get a blood return from the line. A picc line may requested for a variety of treatment options which include some of the following.
Picc line flushes but no blood return private care. Policy and procedure flushing and or blood withdrawal aspiration procedure for picc line and midline catheters purpose. If your picc line has a clamp, it should always be closed when the line is not being used. This guideline provides recommendations regarding best practice for the use and management of invasive devices based on current. It is a silicone or polyurethane long hollow tube that is. A chest xray is required to confirm placement, unless tip locator technology e. If you need to have blood transfusions often, you may need a picc or midline. Caring for a peripherally inserted central catheter or. The line must not be left unclamped when the caps are not in place. The category of central line care and maintenance includes care of central lines and staff competencies related to these. If your picc line is filling with blood on a regular basis after you heplock it, you might consult your nursing service. The nurses of vam are experts at inserting piccs as well as their care and maintenance. Care of peripherally inserted central catheters picc cc 80018 page 5 of 31 learning module this is a controlled document for internal use only. Improving peripherally inserted central catheter picc care.
Central lines are ivs which allow medications to be given into large veins in the body, or to draw blood for lab work. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. Nurses may have to perform phlebotomy for their patient in various health care settings. Peripherally inserted central catheter picc line mayo clinic. Push in the extra vacutainer tube or use the syringe to draw off waste blood at least three times the catheters priming volume. Blood samples may be collected through a picc or midline catheter. I realized i forgot to stop the tpn before drawing from the line. Best practices in phlebotomy who guidelines on drawing. Flush the picc line with a 10 to 20ml normal saline. The cdc specified that picc blood draw procedure should be as follows. Scrub catheter cap with alcohol and allow to air dry 8. There are evidence in the literature showing blood draws from existingindwelling piv have been found to be reliable for many routine blood tests. A nurse is preparing to take a blood sample from a clients arterial line.
Drawing blood from a central in clinical, whenever i had to draw blood off a central line my instructor and the nurses i followed had me waste 10ml before pulling the actual sample. Nclex transfusions blood, parenteral, central lines. If done properly, you can definitely draw from a picc line unless its against policy of course. Students should study venipuncture in books and watch licensed nurses in clinical. Serious risks from common iv devices mean doctors should choose carefully, um experts say trio of um papers looks at blood clot risks from picc lines, and guides physicians on how to make the best vascular access choice for each patient. Policy and procedure flushing and or blood withdrawal. Make sure to follow your hospitals policy when drawing blood. Flush with 1020 ml of normal saline clamping the catheter as flushing is completed, if necessary and promptly dispose. Be sure to ask them how to ensure a slightly turbulent flow, safely.
It is a silicone or polyurethane long hollow tube that is inserted into a peripheral vein in the arm or in the upper arm using an ultrasound guide. About your peripherally inserted central catheter picc. An inset shows a picc line in the arm with a clear plastic dressing over it. 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.
Picc line carehow to care for picc lines in nursing clinical settings. However, the soft plastic can collapse under the negative pressure of drawing blood, causing turbulence and hemolysis. Yes, a nurse can draw blood from an existing peripheral iv and at the time of insertion. This material stays open under positive pressure of iv fluids or medication delivery. Blood cultures drawn at the time of line insertion can be considered venipunctures. Jan 09, 2014 presented by shows how to withdraw blood and then replace old red cap with new pair of maxplus caps on a picc line.
Picc lines are also safe for patients to take home and administer medications intravenously. Adding a clabsi to your patients hospital list, isnt the best of ideas. Who library cataloguinginpublication data who guidelines on drawing blood. 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. Mar 21, 2018 video 2 from a series of 4 on picc line care. Catheters without valves will always require a clamp to prevent blood reflux or air entry into the lumens. Discard it immediately in the appropriate waste container so it doesnt get confused with lab samples. Insert or discontinueremove midlines, piccs, central lines, and portacath needles. Care of a peripherally inserted central catheter picc this information will help you to safely care for your child after discharge or when on temporary leave from the hospital with a picc line a picc line is a soft, fine, hollow tube that is inserted into a vein in your childs upper arm or.
If the picc fails to give a blood return, flush the picc with saline and ask the. They can show you the technique for heplocking your line that is best suited for your device. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career. Picture 1 picc lines come in various types and number of lumens. This video has been jointly created by interventional radiology, fluoroscopy and cardiology services and. Difficult access patient noncompliance those getting a freshly iv placed only draw through an iv when necessary prior. Instead they give the following process as the one to follow when drawing blood from a picc line cdc, 2011. Nursing procedure manual catheter irrigation flushing to maintain patency. The patient was from a local skilled nursing facility and was being treated for an infection. A flash or sluggish return is not acceptable and requires further assessment. Laboratory blood draws perform peripheral venipuncture according to lab requirements for all ages, same as a phlebotomist.
Central line insertion and how to draw blood from new to icu. Stop all infusing fluids for at least 1 minute before drawing a specimen 7. South dakota board of nursing lpn scope of practice. Policy and procedure flushing and or blood withdrawal aspiration procedure for picc line and midline catheters. Certain picc lines may be used to measure the pressure of the blood flowing in. Stroke end of life symptoms a stroke is a medical condition in which poor blood flow to the brain results in cell death. Mayo medical laboratories interpretive hand book rochester, minnesota. Can you draw blood from single lumen picc to arm answers. Taking this class does not permit you to start ivs or draw blood samples.
302 622 1065 1367 1204 1470 619 436 972 352 1120 922 1124 291 1065 90 1135 590 268 966 260 378 1506 199 1326 138 330 283 21 1158 129 568 1306 994