It is important to learn how to maintain and clean the picc line and dressings, as well as flushing. Who library cataloguinginpublication data who guidelines on drawing blood. Picture 1 picc lines come in various types and number of lumens. Jun 30, 2004 krissee, i work at 2 different hospitals in indiana. We have a few physicians who will not allow the nurses to draw blood from their central lines. Picc line insertion can be done by a nurse, doctor or other trained medical provider. Adding a clabsi to your patients hospital list, isnt the best of ideas. 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. Picc line teaching 1639 instructed patient caregiver for minimizing problems associated with picc lines, guidelines include. When drawing blood from a double lumen picc line, which has tpn running do you1 flush with 10mls of normal saline, pull back 10mls of blood discard and throw that away before taking your sample. Is it appropriate to draw blood for lab work from picc lines. You can draw blood from a cvc using the discard method with direct vacutainer connection or a syringe or using the pushpull method with a syringe.
Graduate nurses gns as assigned, gns provide picc care with direct supervision until determined. It is intended to teach the principles of line care, but not intended to be an instructional video. The cephalic vein is another option for piccline placement but, in addition to. Policy and procedure flushing and or blood withdrawal aspiration procedure for picc line and midline catheters purpose. Risks associated with drawing blood specimens from a picc include. A 10ml barrel syringe should be used to flush picc lines because the pressure exerted by a smaller barrel poses a risk for rupturing. Picc lines are commonly used for intravenous therapies that will take a long time. While not commonly taught in nursing school, programs recommend nursing students take extra courses to hone this skill. Care must be taken not to dislodge the catheter when attending dressing changes and removing any securement devices and accessories. How to draw blood from a picc line nurses experience. Use 10 ml syringe to withdraw required amount of blood for laboratory test.
This chapter covers all the steps recommended for safe phlebotomy and reiterates the accepted principles for blood drawing and blood collection 31. How to draw blood drawing blood clinical nursing skills for rns. Central line insertion and how to draw blood from new to icu. Flush the picc line with 10 ml of sterile saline after drawing blood. Improving peripherally inserted central catheter picc. It may be necessary to draw a patients blood for a number of reasons, and it is necessary to draw blood. Using picc lines to draw blood is a common practice in the. Check out these bestsellers and special offers on books and. However, my didactic instructor says this is not best practice and is unnecessary. Has anyone come across any research in regard to drawing blood from piccs and central lines. Lock the prefilled normal saline syringe to the port using a luer adaptor. Indicate maximum injection rates and prompts users to check catheter patency.
Aspirate first to determine picc patency, then flush with 510 ml of normal saline before drawing any blood. 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. This material stays open under positive pressure of iv fluids or medication delivery. Discard syringe with blood into punctureproof container. The patient was from a local skilled nursing facility and was being treated for an infection. A dysrhythmia is an abnormal heart pattern indicated on the electrocardiogram.
Active learning templates therapeutic procedure a therapeutic procedure active learning template. Peripherally inserted central venous catheters picc. Withdraw maximum of 3 ml blood normal saline mixture the internal lumen of a 20gauge picc catheter is 0. It is stated however, that strict aseptic technique must be utilized when drawing blood at this particular site to prevent infection as well as contamination of the line.
The larger veins in your chest carry more blood, so the medicines are diluted much faster. Reducing the risk of central lineassociated bloodstream. 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. Lpn scope of practicepicc linesjust moved to indiana.
Established plan of care the plan of care for blood withdrawal from a picc may be considered established when the patients picc has been previously accessed for blood withdrawal, and is known to be patent and uncomplicated. How to draw blood drawing blood clinical nursing skills. Valved catheters prevent backflow of blood into the catheter when the system is open. Manufacturers specific recommendations should be noted and adhered to by individual practitioners. If your picc line has a clamp, it should always be closed when the line is not being used. Weve been taught to check for a blood return every shift.
Make sure to follow your hospitals policy when drawing blood. A picc, also called a picc line, is a long, flexible catheter thin tube thats put into a vein in your upper arm. 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. Some lines have caps at the end that stop air from getting into the line. Scrub catheter cap with alcohol and allow to air dry 8. Use 5 ml sterile saline to flush the picc line before and after medication is administered. As nurses enter the clinical setting, they will have to know how to draw blood as part of their clinical skills experiences. There are there is usually one, two, or three lumens iv. Oct 06, 2009 picc lines are commonly used for intravenous therapies that will take a long time. 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. Best practices in phlebotomy who guidelines on drawing. Picc line blood draw explained e phlebotomy training. It helps children learn why chris has a picc line, what it does, how it works and how chris got it. This book is distributed under the terms of the creative commons.
Lpn scope of practicepicc linesjust moved to indiana page. Nov 15, 2019 peripherally inserted central catheter picc. Nov, 20 this video has been made to demonstrate proper flushing and blood withdrawal from a central line. Published by the royal college of nursing, 20 cavendish square, london w1g 0rn c 2016 royal college of nursing more. Picc line flushes but no blood return private care. Understanding your peripherally inserted central catheter picc what is a picc line. If your picc line is filling with blood on a regular basis after you heplock it, you might consult your nursing service. If a physician orders a single blood culture, the nurse is authorized to obtain a second set. Improving peripherally inserted central catheter picc care.
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. When we look at best practice, we know that we should not use central lines that do not produce a blood return. Iv nurses society standards the intravenous nurses societys standards do not support the practice of drawing blood specimens from peripheral iv lines. The program features 8 learning modules that take the participant, step by step, through the essential elements of infusion therapy. Request pdf drawing blood samples from vascular access devices. Does it increase the risk of infection within the catheter. Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. An intravenous line attached to the picc is also shown. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. Be sure to ask them how to ensure a slightly turbulent flow, safely.
The picc is put into a large vein by a certified nurse or doctor. Or you could have some fibrin at the end of your line which may require it to be declotted. A picc line is a thin, flexible, hollow tube placed in a vein in your arm, usually above the elbow. No blood return from the picc line cvc health care. 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. Aug 31, 2017 adding a clabsi to your patients hospital list, isnt the best of ideas. Purpose this guideline has been developed as part of the icare intervention bundle for the management of intravascular devices ivds. The promise of novel technology for the prevention of intravascular. The plan of care must be documented in a nursing care plan.
Patient care plan for care of peripherally inserted central catheter picc the care plan is designed to be used in conjunction with cins guidelines for vascular devices. 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. 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. In most hospitals, picc lines are inserted when therapy is anticipated to last more than 7 days especially with corrosive medications or fluids. Cvads vary in lumen size, numbers of lumens, placement and usage. I drew a peak or was the trough first, cant remember anyway, drew the lab. Picc or peripherally inserted central catheter is used for intravenous access in the medium to longterm. An inset shows a picc line in the arm with a clear plastic dressing over it.
The chapter includes background information section 2. The nurse called and stated they were unable to get a blood return from the line. 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. 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.
Learn some tips when drawing blood as a nurse, nursing student, or as a part of clinical skills. This led to compromised patient care by delaying drug administration and blood sampling whilst alternative intravenous access was obtained. Always wash hands before touching the picc line, do not allow any sharp objects near the line, do not clean the skin near. 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. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career. If youre drawing blood from a multilumen catheter thats infusing drugs or fluid, stop the infusions before the blood draw. The category of central line care and maintenance includes care of central lines and staff competencies related to these. How to draw blood with venipuncture drawing tips blood draw tomorrow i go in for blood draws and ultra sounds and other fun things.
Stop all infusing fluids for at least 1 minute before drawing a specimen 7. Picc line care picc line dressing change clinical nursing. Policy and procedure flushing and or blood withdrawal aspiration procedure for picc line and midline catheters. 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. 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. Gently plugs the insertion site and provides excellent kink resistance. May 23, 2018 central venous access device cvads are multipurpose venous catheters that terminate at or close to the heart or in one of the great vessels. Peripherally inserted central catheter picc line mayo clinic.
How to draw blood from a picc line general nursing. Has anyone come across any research in regard to drawing blood from picc s and central lines. 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. Flushingheparinizing picc line before and after peak and. This information explains what a peripherally inserted central catheter picc is and how its placed. Llpc, ma, ccls, the book reassures kids about peripherally inserted central catheters and helps them understand more about their medical condition and.
Guideline for peripherally inserted central venous catheters picc. 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. It is important not to get any air into your picc line. This guideline provides recommendations regarding best practice for the use and management of invasive devices based on current. This led to compromised patient care by delaying drug administration and blood sampling whilst. If the gauze becomes soaked with blood, a nurse should be told to change the dressing.
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. Flushing and blood withdrawal from a central line youtube. Nursing procedure manual catheter irrigation flushing to maintain patency. Groshong and groshong n xt picc and midline blood withdrawal hub to hub perqcath picc and midline blood withdrawal 1. 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. 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. Click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. Picc lines are also safe for patients to take home and administer medications intravenously. This video has been made to demonstrate proper flushing and blood withdrawal from a central line.
The line must not be left unclamped when the caps are not in place. Using pushpause flushing method, slowly flush saline into the catheter. Manufacturers specific recommendations should be noted. One of the things you will encounter as a nurse is a picc line also called a peripherally inserted central catheter. Care of a peripherally inserted central catheter picc. Students should study venipuncture in books and watch licensed nurses in clinical.
Understanding your peripherally inserted central catheter. It may occur with catheter malposition or dislodgement. It also has general guidelines for caring for your picc at home. Policy and procedure flushing and or blood withdrawal. Results for nursing care of picc line 1 10 of 57 sorted by relevance date. Unique purple polyurethane material indicates that the powerpicc catheter is a bard power injectable catheter. A flash or sluggish return is not acceptable and requires further assessment. Use 10 ml syringe and withdraw 5 ml of blood and discard appropriately in biohazard container 9. Find out what to expect during and after picc line insertion. Picc line carehow to care for picc lines in nursing clinical settings.
Patient care plan for the care of peripherally inserted. 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. Percutaneous central catheter picc statpearls ncbi bookshelf. Drawing blood samples from vascular access devices. Guideline peripherally inserted central venous catheters picc 1. Generally, picc lines are not sutured and are heldin place by the non suturing securement device, the dressing, and any steristrips if used. Drawing blood from a peripherally inserted central catheter picc is a skill that nurses perform. Peripherally inserted central catheter picc childrens. Care of peripherally inserted central catheters picc cc 80018 page 5 of 31 learning module this is a controlled document for internal use only. Inserting, repairing, or removing arterial and central venous catheters, including picc lines. I will hopefully know whats wrong with me by thursday afternoon. About your peripherally inserted central catheter picc. Accessremove a noncoring needle from an implanted subcutaneous port.
Nursing practitioner printing videos architecture home favorite part of my job phlebotomy is the process of vein incision. Meticulous attention to some simple precautions can help prevent the common complications associated with central venous access devices. Mar 21, 2018 video 2 from a series of 4 on picc line care. The book reassures kids and helps them learn about picc lines. 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. Any documents appearing in paper form are not controlled and should be checked against the electronic file version prior to use.
Understanding your peripherally inserted central catheter picc. When leaving hss, the patient is provided with an information book, phone. However, many institutions have dedicated teams of picc nurses. It is about 18 24 inches long and goes into the large vein near your heart. Blood cultures drawn at the time of line insertion can be considered venipunctures. Registered users can save articles, searches, and manage email alerts. They can show you the technique for heplocking your line that is best suited for your device.