Users of these guidelines should read chapters 2 and 3 before reading the information given below. Blood draw procedure and techniques e phlebotomy training. With over 1,700 procedures and skills from a wide variety of nursing specialties including allied health, it combines the most trusted clinical content with powerful online workflow functionality that will enable your clinical staff to save time, standardize care and deliver. Choose central line blood for a blood culture from a picc, introducer, dialysis catheter or tunneled. Most staff when working with picc s, ivs, tessios or central lines dont clear the ports correctly before drawing labs or cultures thats why a lot of false positive are resulted if drawing from indwelling lines you do not have to waste with cultures. Guideline for peripherally inserted central venous catheters picc. Peripherally inserted central catheter picc line mayo. Peripherally inserted central catheter picc is a long, narrow tube catheter about the same size as a strand of long spaghetti. Central line insertion and how to draw blood from new to icu. The internist i was observing told me it was called coffee cream blood maybe he made it up. Nov, 20 this video has been made to demonstrate proper flushing and blood withdrawal from a central line. How you can draw blood at askives can you draw blood from a doublelumen picc line which is used primarily for tpn.
Although rare, blood clot formation can take place in lungs because of picc line insertion. Collection and inoculation of blood specimens for routine culture bacterial, t. Phlebotomy uses large, hollow needles to remove blood specimens for lab testing or blood donation. A picc line gives your doctor access to the large central veins near the heart. Active learning templates therapeutic procedure a therapeutic procedure active learning template.
Peripherally inserted central catheter show low, az picc. Central venous lines pediatric surgeons of phoenix. Im not sure if they will replace the picc since i am 8 months pregnant. Remove the first 3 to 5 ml of blood and then discard. Instead, draw a sample directly from the hub and inject it into a blood culture vial.
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. Peripherally inserted central catheter picc childrens. A picc line generally isnt recommended if theres a chance you may one day need dialysis for kidney failure, so let your doctor know if you have a history of kidney disease. 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. It is put into one of the large veins of the arm, above the bend of the elbow. Blood draw procedure and techniques blood draw best practices, order of draw, and proper procedure, the practice of drawing blood from a vein or phlebotomy is essential for a variety of medical procedures and tests to diagnose a patient. Quick question for those with picc line experience. Excessive force could cause a flexible picc to temporarily collapse and. A picc will provide an effective method of drawing blood or delivering medications and nutrients into a patients bloodstream over a period of weeks or months. Using picc lines to draw blood is a common practice in the medical unit where i work. Iv training in all locations on this model includes manual activation of venous blood flow fluids can be withdrawn or administered with realistic flashback. Flushing and blood withdrawal from a central line youtube.
Using pushpause flushing method, slowly flush saline into the catheter. Drawing equal volumes of blood from both sites is extremely important. No matter which method you use, stop all infusions before drawing blood and dont reinfuse. When drawing blood from a doublelumen central venous catheter, the proximal port is used because it is usually the port with the largest lumen. A specialist nurse or doctor places a picc line into a large vein in your arm and. A picc line can help avoid the pain of frequent needle sticks and reduce the risk of irritation to the smaller veins in your arms a picc line requires careful care and monitoring for complications, including infection and blood clots. Use the initial specimen of blood obtained from the catheter for the blood cultures. Learning how to draw blood is essential to becoming a phlebotomist.
Central lines are ivs which allow medications to be given into large veins in the body, or to draw blood for lab work. How to draw blood from a picc line general nursing. A picc line can be easily removed when it is no longer needed. If it fails the ability to give and take, then there is a problem with the device. The peripherally inserted central catheter or picc line is a thin flexible tube that is inserted through a peripheral vein into a main vein for easy administration of drugs and fluids and for drawing blood over a long period of treatment. Picc lines use blood vessels farther away from the large arteries found near the. Draw up 10 cc normal saline in syringe and set aside 0. Groshong and groshong n xt picc and midline blood withdrawal hub to hub perqcath picc and midline blood withdrawal 1. What to know about picc lines and ports cancer 101. A picc line requires careful care and monitoring for complications, including infection and blood clots. For long term treatment of ailments such as diabetes, cancer, tpn, lyme disease, or just about any condition that requires regular intravenous medication and blood drawing for tests, the doctor may recommend a peripherally inserted central catheter or picc line. The information given here supplements that given in chapters 2 and 3. Part of the port or picc line maintenance procedure involves the ability to draw blood back through the device.
The picc needs to be flushed once weekly with 10mls of 0. 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. Picc line blood draw explained e phlebotomy training. Aug 31, 2017 adding a clabsi to your patients hospital list, isnt the best of ideas.
If slow and gentle does not produce a blood return, change to a smaller syringe. 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. If the line is no longer where it should be inside your vein, then it may not provide the ability to draw back from that location. Nov 19, 2010 clean the skin around the line once more, dry, and cover with occlusive dressings. All cultures should be obtained using the same volume of blood e. 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. Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. Peripherally inserted central venous catheters picc.
Understanding the procedures, processes and reasons behind phlebotomy is the key to. You need to rinse out the catheter after every use. Drawing blood samples from vascular access devices. Allowing patients to feel more comfortable and at ease during their treatments. The procedure to insert the picc line takes about an hour and can be done as an outpatient procedure, meaning it wont require a hospital stay. No blood return from the picc line cvc health care. A picc line is a long, thin, hollow, flexible tube called a catheter.
Adding a clabsi to your patients hospital list, isnt the best of ideas. Disinfect top of blood culture bottles with an alcohol pad. A blood test to check for potential bleeding complications may be requested. It is important to learn how to maintain and clean the picc line and dressings, as well as flushing. Access midline catheter with 10ml syringe, using aseptic technique. A picc line peripherally inserted central catheter line is used to give someone chemotherapy treatment or other medicines. My infusion line worked great, however my other line has no blood return. Mayo medical laboratories interpretive hand book rochester, minnesota.
The insertion of the picc line does not require surgery. The cdc specified that picc blood draw procedure should be as follows. This chapter covers background information section 5. Position arm in gravity dependent position with palm up. These catheters are used to draw blood drawing and administer medication and nutrition, which could be too irritating to the smaller veins of the arms or the legs. Both can become infected with bloodborne organisms such as hepatitis b, hiv, syphilis or malaria. Picc line flushes but no blood return private care. Aspirate first to determine picc patency, then flush with 510 ml of normal saline before drawing any blood. The centers for disease control and prevention cdc does not state that it is inappropriate to draw blood from a picc line. Maintain aseptic technique when accessing the catheter as outlined. Lock the prefilled normal saline syringe to the port using a luer adaptor.
Who library cataloguinginpublication data who guidelines on drawing blood. Each step in the process carries risks both for patients and health workers. If you want to check for a blood stream infection from the line, you do waste. After identifying the site for the blood draw, gather the appropriate supplies needed. Trouble getting a blood return hadaway associates blog lynn. The picc lines commonly used at hss has a patented groshong valve, which offers an advantage of not requiring a blood thinner to be mixed with the saline flushes. For either, we would change the cap prior to the draw. Stop any iv fluids infusing through the catheter including another lumen of the. Some central lines are actually threaded through the smaller veins of the arm or leg and advanced into the larger veins of the chest socalled picc lines, or peripherally inserted.
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. This guideline provides recommendations regarding best practice for the use and management of invasive devices based on current. There should be at least two new codes, neltner says. Peripherally inserted central catheter picc line mayo clinic. We will see how my blood draw goes on monday and see what they say then.
Lc0211 b sample midline catheter policy and procedure. Order a chest xray to check for line position and pneumothorax if a jugular or subclavian line has been inserted. One of the things you will encounter as a nurse is a picc line also called a peripherally inserted central catheter. I have been flushing my picc line twice a day with saline and heparin to see if that would help. Its generally used to give medications or liquid nutrition. 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. Make sure to follow your hospitals policy when drawing blood.
The way i understand it, if you want to check the line for infection, you dont waste and you would want to have 2 peripheral sticks to go along with it to check for blood stream infection. It is also used to take blood when you need to have blood tests. Switch up 2 other vascular access device codes to match cpt 2008years have passed since cpt first heard the request for a picc blood draw code, but the latest code offerings deliver. If collecting a blood culture that requires isolator microbial system afb or fungus, prep stopper with alcohol. Lippincott procedures is your online source for instant, evidencebased procedure guidance at the point of care. Peripherally inserted central catheters piccs page 6 of 12 3. Write date changed on tubing change sticker and attach to tubing. It can be left in place for weeks, months, and even years. How to find a vein when starting ivs or drawing blood tips in the arm duration. Additionally, since the published average dwell time for short peripheral ivs is 44hrs, a midline should. If you need to draw blood from a cvc for culturing, dont flush the catheter first. The trubaby x also facilitates picc line training in infants including the complete picc line procedure.
If your institution currently is a subscriber to lippincott procedures and you are having difficulty accessing it, please contact our technical support help desk at. In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous blood sampling also called phlebotomy or intravenous therapy. 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. Blood drawing through a midline catheter diagnostic blood draws may be performed through a midline catheter as follows. As with all central lines, 10 mls is the minimum size syringe to be used to flush a picc line.
Collection and inoculation of blood specimens for routine. Inject enough flush solution to clear residual blood from the catheter. Instead they give the following process as the one to follow when drawing blood from a picc line cdc, 2011. The nurse told me to do that hopefully it will work. During the insertion procedure, damage can occur to the nerves, blood vessels or tissues near the site of insertion. Trouble getting a blood return lynn hadaway associates. Cpt 2008 adds 36592 collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified, satisfying the need for a code to report drawing blood from a peripherally. Students should study venipuncture in books and watch licensed nurses in. 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. On a peripheral vein, you could be pulling the vein wall over the catheter lumen as in this drawing. If drawing blood from a peripherally inserted central catheter picc line or. Peripherally inserted central venous catheters picc 1. For blood cultures, the initial specimen is used for the sample, and the line is not flushed beforehand. It is a proficiency that nurses should learn, and phlebotomists continue reading.
Shut off intravenous iv fluids infusing through line and clamp lumen. 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. It helps carry nutrients or medicine into your body. Policy and procedure flushing and or blood withdrawal. Subclavian vein insertion with catheter pinched between clavicle and first rib. Policy and procedure flushing and or blood withdrawal aspiration procedure for picc line and midline catheters purpose. Discard syringe with blood into punctureproof container. And, in order to do so, one must learn and follow the proper steps to collecting blood from gathering the right equipment to transporting the sample to the laboratory. Unlike other procedures for collecting blood samples, picc blood draw has a set of steps that must be followed. Comparison of two blood sampling methods in anticoagulation therapy. It helps children learn why chris has a picc line, what it does, how it works and how chris got it. Removal of blood is generally easier from a central line than from a. The picc line is placed to provide repeated access to your veins for a variety of circumstances such as long term medication treatment, like chemotherapy, blood draws and for nutrition. It is used to give you medication directly into your blood stream without having to repeatedly insert a needle into your vein.
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. Clinicians should remove blood or ooze from catheter insertion site with. Purpose this guideline has been developed as part of the icare intervention bundle for the management of intravascular devices ivds. Jan 14, 2020 draw two sets of peripheral blood cultures from different sites and one set of cultures from the distal port of the line. The promise of novel technology for the prevention of intravascular. When leaving hss, the patient is provided with an information book, phone number and a pager number for contact to address any questions or concerns about the picc. The stepbystep guide to professionally drawing blood. It is intended to teach the principles of line care, but not intended to be an instructional video. Blood cultures drawn at the time of line insertion can be considered venipunctures.
Assess the picc insertion site according to your facilitys policy. Oct, 2017 arm with picc line arm with a preexisting or current blood clot. Withdraw maximum of 3 ml blood normal saline mixture the internal lumen of a 20gauge picc catheter is 0. Ensure that you can aspirate blood from each lumen of the line, then flush each lumen with saline or heparin saline. Picc line carehow to care for picc lines in nursing clinical settings. A picc line, or peripherally inserted central catheter, is thin, soft plastic tubing that functions as a longterm iv line, allowing medical professionals a simple, painfree way to draw blood or give medications or nutrients as needed. Phlebotomy tips from the pros when drawing blood, right before the actual stick, i ask the patient to take a deep breath. The blood was creamy blood but creamy with a ring of white that settled at the top. When leaving hss, the patient is provided with an information book, phone number and a. There is no need to withdraw blood into the syringe prior to a routine flush with saline rcn 2010. Blood samples can also be taken through the picc for testing. This video shows how to change a picc line dressing. Find out what to expect during and after picc line insertion.
Each morning, during flush we always check for blood return. In healthcare, this procedure is performed by medical laboratory scientists, medical practitioners, some emts, paramedics, phlebotomists, dialysis technicians. I have 2 lumens, one for iv hydration and 1 just in case need for tpn. Arterial blood sampling who guidelines on drawing blood. Excessive force could cause a flexible picc to temporarily collapse and occlude the backflow of blood. This was a man from the deep south originally and the doctor said his diet probably had deep fried foods in it every day. Jul 11, 2006 for now, you should include the picc blood draw as part of the evaluation and management service, but you cant use this service to raise your em levels, says neltner, who proposed the change. Access the catheter as outlined above, maintaining aseptic technique. Flushing and taking blood from a picc line youtube.
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