It is also used to take blood when you need to have blood tests. If blood return cannot be obtained from a central venous line, refer to the central venous line occlusion management and declotting procedure cen05. Although rare, blood clot formation can take place in lungs because of picc line insertion. No matter which method you use, stop all infusions before drawing blood and dont reinfuse. Peripherally inserted central catheter picc childrens. Who library cataloguinginpublication data who guidelines on drawing blood. A peripherally inserted central catheter, also known as a picc line, is a long, thin, hollow plastic tube that inserted into an arm vein. Guideline peripherally inserted central venous catheters picc 1. Using pushpause flushing method, slowly flush saline into the catheter.
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. A picc line typically takes the place of a standard intravenous line, or iv, since it can stay in place for an extended period of time. Flushing and taking blood from a picc line youtube. 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. Nov 19, 2010 central venous line placement is typically performed at four sites in the body. Stop any iv fluids infusing through the catheter including another lumen of the catheter.
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. Withdraw maximum of 3 ml blood normal saline mixture the internal lumen of a 20gauge picc catheter is 0. Blood cultures drawn at the time of line insertion can be considered venipunctures. There are there is usually one, two, or three lumens iv. Drawing blood from a peripherally inserted central catheter picc is a skill that nurses perform.
Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. Obtain a needleless blood transfer device to draw blood. Blood drawing through a midline catheter diagnostic blood draws may be performed through a midline catheter as follows. The catheter is tested for blood return and then flushed with sterile, normal saline. While not commonly taught in nursing school, programs recommend nursing students take extra courses to hone this skill. Draw up 10 cc normal saline in syringe and set aside 0. Picc line blood draw explained e phlebotomy training. This was a man from the deep south originally and the doctor said his diet probably had deep fried foods in it every day. Flushing and blood withdrawal from a central line youtube. Other sources that outline blood draw from picc line provide a similar process but more extensive and specific. Disinfect culture bottles or isolator tubes with an alcohol pad prior to venipuncture. Understanding your peripherally inserted central catheter picc. When drawing blood from a doublelumen central venous catheter, the proximal port is used because it is usually the port with the largest lumen.
Purpose this guideline has been developed as part of the icare intervention bundle for the management of intravascular devices ivds. Students should study venipuncture in books and watch licensed nurses in. Blood can be collected by venipuncture of peripheral veins or from intravascular catheters. Aspirate first to determine picc patency, then flush with 510 ml of normal saline before drawing any blood. Drawing blood from picc infusion intravenous nursing. 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.
Assess the picc insertion site according to your facilitys policy. A peripherally inserted central catheter picc is a long, thin tube that goes into your body through a vein in your upper arm. Lock the prefilled normal saline syringe to the port using a luer adaptor. Graduate nurses gns as assigned, gns will withdraw blood from picc, short term, tunneled and implanted central venous catheters with direct supervision until determined by an rn supervisor to be competent to practice autonomously. When bacteria multiply at a rate that exc eeds the capacity of the reticuloendothelial system to remove them. Policy and procedure flushing and or blood withdrawal aspiration procedure for picc line and midline catheters purpose. Discard it immediately in the appropriate waste container so it doesnt get confused with lab samples. Additionally, there are times when drawing blood from an iv is difficult. A picc must be ordered by your primary physician or surgeon or their consulting colleague. Understanding your peripherally inserted central catheter picc what is a picc line. Instead they give the following process as the one to follow when drawing blood from a picc line cdc, 2011. If blood is obtained from an intravenous catheter, a corresponding specimen should also be obtained by venipuncture. Lippincott procedures is a webbased tool and can be accessed via the internet from within your organization via ip authentication, athens authentication, or referral access. Guideline for peripherally inserted central venous catheters picc.
Flush the picc line with a 10 to 20ml normal saline. Tbu patient info procedures picc lines the blood unit. The tip of the catheter is positioned in a large vein that transfers blood into the heart. You have a peripherally inserted central catheter picc. This chapter covers all the steps recommended for safe phlebotomy and reiterates the accepted principles for blood drawing and blood collection 31. Determining optimal waste volume from an intravenous catheter. It also has general guidelines for caring for your picc at home.
This chapter describes only the procedure for a radial artery blood draw. 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. These lines are inserted into a neck vein or a vein deep in the chest. Peripherally inserted central catheter picc is a long, narrow tube catheter about the same size as a strand of long spaghetti. A picc line is a long, thin, hollow, flexible tube called a catheter. Central line insertion and how to draw blood from new to icu. Use the initial specimen of blood obtained from the catheter for the blood cultures. In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of intravenous therapy or for blood sampling of venous blood. Central lines are ivs which allow medications to be given into large veins in the body, or to draw blood for lab work. Peripherally inserted central venous catheters picc.
Central venous line placement is typically performed at four sites in the body. The chapter includes background information section 2. The blood was creamy blood but creamy with a ring of white that settled at the top. It is used to give you medication directly into your blood stream without having to repeatedly insert a needle into your vein. How to find a vein when starting ivs or drawing blood tips in the arm duration. The priming volumes on all cvcs are lower than you would think. Active learning templates therapeutic procedure a therapeutic procedure active learning template. Understanding your peripherally inserted central catheter. A 20 ml preflush is really not necessary but it is really important to immediately flush with a good volume 1020 ml after the blood draw. The main priority you have during this procedure and most procedures is to monitor vital signs. Yes, provided that you pause the infusion of heparin prior to taking your lab sample. Jul 11, 2006 prepare for possible picc blood draw codes published on tue jul 11, 2006 in the meantime, avoid 36415 mistakes with this tip new oncology codes may be coming your way in 2007, judging from reports from the cpt editorial panel meeting in las vegas on june 910. You need to rinse out the catheter after every use.
Several different arteries can be used for blood collection. The cdc specified that picc blood draw procedure should be as follows. Someone there said shed fix it by power flushing the line i wasnt there and dont know exactly what happened, but there was some uproar over it. What to know about picc lines and ports cancer 101.
The information below tells you what to expect when the picc is inserted. The largest volumes will be ports and tunneled cvcs ie. Bacteria enter the blood stream from extrava scular sites via the lymphatic vessels. Policy and procedure flushing and or blood withdrawal. Prepare for possible picc blood draw codes published on tue jul 11, 2006 in the meantime, avoid 36415 mistakes with this tip new oncology codes may be coming your way in 2007, judging from reports from the cpt editorial panel meeting in las vegas on june 910. Choose central line blood for a blood culture from a picc, introducer, dialysis catheter or tunneled. Becky, first time this happened with husbands picc, doc sent us to hospital for them to use tpa. 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. Peripherally inserted central catheter this information leaflet aims to help answer some of the questions you may have about your peripherally inserted central catheter picc line. Also, prior to drawing back blood from the picc line infuse 10cc of normal saline and then draw off a waste. Lippincott procedures is your online source for instant, evidencebased procedure guidance at the point of care. Using picc lines to draw blood is a common practice in the. Lc0211 b sample midline catheter policy and procedure. Use a cvad with the minimum number of ports or lumens essential for the management of the patient.
A picc line peripherally inserted central catheter line is used to give someone chemotherapy treatment or other medicines. The picc needs to be flushed once weekly with 10mls of 0. Learning how to draw blood is essential to becoming a phlebotomist. The promise of novel technology for the prevention of intravascular. Blood culture collection procedure principle detection of organisms in a patients blood has diagnostic and progn ostic importance. There is no logon required to view procedures, so nurses and clinicians quickly get to the information they need. Someone there said shed fix it by power flushing the line i wasnt there and dont know exactly what happened, but there was some uproar over it because of possibly flushing clot off into blood stream.
Your health care provider has determined that you need a picc. How to draw blood from a picc line nurses experience. Clinicians should remove blood or ooze from catheter insertion site with. If necessary, clamp the catheter when flushing is complete. 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.
This information leaflet will explain why you need a picc line, what to do before you come in for the procedure and how to care for it when you are at home. Push in the extra vacutainer tube or use the syringe to draw off waste blood at least three times the catheters priming volume. The larger veins in your chest carry more blood, so the medicines are diluted much faster, reducing the risk of. How to flush a picc line peripherally inserted central catheter duration. 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. When leaving hss, the patient is provided with an information book, phone number.
For blood cultures, the initial specimen is used for the sample, and the line is not flushed beforehand. Accidental needle stick after drawing blood in picc line and transfering blood into test tube for labs. It is about 18 24 inches long and goes into the large vein near your heart. 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. As with all central lines, 10 mls is the minimum size syringe to be used to flush a picc line. Can an appt lab result be drawn from a picc line when heparin. The purpose of the picc insertion procedure is to provide medicinal therapy and fluids through an intravenous catheter. Is it appropriate to draw blood for lab work from picc lines. As a nurse, your responsibility is helping the doctor to set up for the cvc insertion.
Access midline catheter with 10ml syringe, using aseptic technique. 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. Drawing 1 ml of waste will prevent clinicians from obtaining extra waste and discarding blood needlessly. 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. Find out what to expect during and after picc line insertion. Nov, 20 this video has been made to demonstrate proper flushing and blood withdrawal from a central line. Peripherally inserted central catheter picc line mayo clinic.
Best practices in phlebotomy who guidelines on drawing. It helps carry nutrients or medicine into your body. Blood samples can also be taken through the picc for testing. A picc line is a thin, flexible, hollow tube placed in a vein in your arm, usually above the elbow. Position arm in gravity dependent position with palm up. Picc lines use blood vessels farther away from the large arteries found near the. 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. A picc line is a thin, soft, long catheter tube that is inserted into a vein in your upper arm. This is a sterile procedure so once the preparation starts, you will be wearing a cap and mask. Groshong and groshong n xt picc and midline blood withdrawal hub to hub perqcath picc and midline blood withdrawal 1. Alternatives include the external jugular and femoral veins. About your peripherally inserted central catheter picc. Increased number of line lumens are associated with increased rates of infection.
Maintain aseptic technique when accessing the catheter as outlined. The centers for disease control and prevention cdc does not state that it is inappropriate to draw blood from a picc line. There is no need to withdraw blood into the syringe prior to a routine flush with saline rcn 2010. Most staff when working with piccs, 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. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career. This fun and informative guide details the stepbystep process of taking a blood sample and makes a great. 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. Nurses obtaining blood samples from a 22gauge iv catheter with a 6inch extension tube should draw a minimum of 1 ml of waste prior to obtaining the sample for testing. In healthcare, this procedure is performed by medical laboratory scientists, medical practitioners, some emts, paramedics, phlebotomists, dialysis technicians, and other nursing staff. Accidental needle stick after drawing blood in picc line and. This guideline provides recommendations regarding best practice for the use and management of invasive devices based on current.
It is put into one of the large veins of the arm, above the bend of the elbow. If unable to obtain a blood waste, may use a sterile 12ml syringe or a vacutainer transfer set. The internist i was observing told me it was called coffee cream blood maybe he made it up. The stepbystep guide to professionally drawing blood. The end of this catheter goes into a large vein near your heart. It is intended to teach the principles of line care, but not intended to be an instructional video. This video has been made to demonstrate proper flushing and blood withdrawal from a central line. 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. Arterial blood sampling who guidelines on drawing blood ncbi.
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