Can You Draw Blood From The Same Arm That Has A Picc Line
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Wednesday, 06/23/2010 - 16:27
#1
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 simply describe it from the PICC". For the sake of the statement: is there documentation that says it is not appropriate to draw blood distally from a PICC line?
Thanks
Wed, 06/23/2010 - eighteen:45
#2
At WoCoVA final week, in that location
At WoCoVA terminal week, there was some discussion about drawing blood samples from all types of CVCs with most speakers proverb that information technology should non routinely be washed due to the increased hub manipulation and it contribution to CRBSI. And so I would only utilize any type of CVC for blood draws when there are specific reasons to avert use of peripheral veins or in that location is a total lack of peripheral veins. When drawing from peripheral veins, here is the social club of preference that I would follow:
ane. draw from the arm opposite the PICC if possible.
2. draw from the ipsilateral side of the PICC in the manus, wrist or lower forearm distal to the PICC insertion site
3. the lower extremity would be the very last resort for cartoon blood samples.
Lynn
Wednesday, 06/23/2010 - twenty:44
#three
Blood draws for PICC lines
Claret draws are appropriate from PICC lines as long equally sterility is maintained during the draw, hub manipulation is minimal, and proper flushing is done post depict. The biggest bug we see is proper flushing not washed.
Sorry merely I have to disagree
Deplorable simply 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 merely one more than grade of manipulation that can introduce organisms into the lumen. Lynn
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 outcome. As a vascular access nurse, I have many patients tell me that nurses are not following the near basic infection prevention measures such equally hand-washing and hub scrub. And patients are now existence subjected to peripheral draws considering of infection and poor flushing techniques. I feel like the educational activity needs to grab up with the literature. I am very saddened equally 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.
Y'all raise many valid points,
You heighten many valid points, but I also call back we often "oversell" the VAD to our patients by promising them that they will practice everything. The fact is that we simply tin not promise this considering there could be many reasons for not being successful with getting a sample - fibrin, thrombus, etc. Infection is but 1 take a chance, although it is taking precedence over all others correct now. I take always thought that the VAD should merely be used for blood sampling when there were no peripheral access, history of vasovagal reaction, etc. I take never thought that all VADs should be used for blood sampling on all patients. I recollect it should be a case-by-case decision. We simply do not accept any research on the affect that blood sampling has on the life and functionality of the catheter. We have very trivial inquiry on the sampling technique and their impact on accurate lab values, except for coagulation studies. At that place are several studies that accept 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 accept found to reduce taking samples from VADs. One other business is nosocomial blood loss and iatrogenic anemia because of frequent use of the VAD for sampling. So there are numerous issues to recall about. lynn
Fri, 06/25/2010 - 23:26
#7
We avoid PICC when possible
I fully agree,
PICC's were non developed for blood sampling in the showtime place. It i true that when using a PICC for blood fatigued we increase the risk of CRBSI, possibility of contaminated blood sample leading to useless removal of the catheter, leading to placement of some other PICC (with discomfort and possible filibuster in treatment) and by and large - in my institution anyways - increase in fractional/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'due south for blood sampling. Correct, patient comfort is an reward to using them but at that place are numerous risks that must be taken into account peculiarly 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.
Mon, 07/12/2010 - 14:35
#eight
So I am understanding all of
Then I am understanding all of yous 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 assistance with poor peripheral vasculature (inability to obtain PIV, inability to notice a site for venipuncture, etc). We have been telling our patients this is one of the benefits of having a picc line......
One of the problems is that
1 of the problems is that we "overselll" CVCs to patients by telling them that they tin be used for everything and they will no longer need to be stuck. This is simulated promises and 1 that is non always in the best interest of our patients. At the contempo 5th Decennial Briefing on Healthcare Associated Infections, a coming together of CDC, SHEA, APIC, and IDSA, in that location was heavy accent on hub and line manipulation increases the risk of introducing organisms that tin can lead to BSI. And then decrease the number of times we open and/or use the CVC elevation as few as possible. We are all trying to accomplish Zero CRBSI now every bit these are seen every bit totally preventable infections. So many hospitals have limited blood draws from all CVCs to a patient specific decision. If at that place are no peripheral venipuncture sites, your only option would be the CVC. If there are available peripheral sites, they would be the commencement choice.
In addition to infection, there are likewise concerns almost obtaining accurate lab values from a catheter drawn sample. The only studies pertain to coagulation lab values, which has all shown they you tin not obtain authentic lab data from a catheter that has been exposed to heparin. Then at that place is the whole result of nosocomial claret loss and iatrogenic anemia from repeated catheter drawn samples and wasting the initial sample drawn.
So this is a patient specific determination based on what is the least hazard to the patient, but it should never be an automatic decision to use all CVCs for all blood samples in all patients. Lynn
Thu, 07/15/2010 - fifteen:45
#10
Blood Draw via PICC's.
Nosotros generally don't place a PICC UNLESS peripheral veins are non available. Of course if Vanco/TPN etc are needed and yous have a 24ga peripheral, we will place a PICC, but and so do you depict through the 24ga for blood?? Most small estimate 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 permit a short PIV to dwell solely for the purpose of drawing blood samples. I hold that patient comfort is an issue but you have to weigh the take a chance vs benefits. A CRBSI from increased hub manipulation from drawing claret samples can cause lots of discomfort, plus increase the risk of death, etc. And dramatically increase the toll of care. Is that worth the price of peripheral sticks? I would totally agree that we need much more accent on venipuncture proficiency and cease the unnecessary sticks from staff that do not have adequate skills. I know that disease procedure causes many vessel changes, merely I also strongly believe that many people have no peripheral veins left because of and then many sticks of unskilled people. Lynn
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