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Virg
Drawing labs through a picc line with TPN infusing

Am asking other institutions how they handle blood draws for patients receiving tpn through their picc  lines.  Is there a recommendation as to stopping the tpn, the amount of blood that is drawn off for waste, etc.  There is some concern as to the validity of the results when drawn through a picc.   I know peripheral labs are generally preferrred, however, it's not always possible.   Any information is greatly appreciated.

valoriedunn
I have my nurses stop the

I have my nurses stop the TPN, flush with 20ml NS and aspirate 5-10ml blood for waste then get the samples.  Our results are pretty good doing it that way. 

 

Valorie Dunn,BSN, RN, CRNI, PLNC

Virg
Drawing labs through picc on those pts on TPN

Thank you for the feedback.  This concerns those patients with no other option but to use the picc due to poor venous access.  I appreciate the information.  If there is anyone else that has a protocol for using picc to draw labs on those patients receiving TPN, any information would be greatly appreciated.

blodahl
Drawing labs through picc on those pts on TPN

We follow same practice as described by Valorie Dunn and agree with Lynn's comments. Additionally, when placing a PICC for TPN in the acute setting, we always ask for at least a DL catheter; one lumen for TPN another lumen for other meds and lab draws. If a patient has a single lumen tunneled device or implanted port with difficult peripheral vein status, we apply a splitter directly on the hub of the catheter/port access needle in order to achieve the lab draw with the least amount of manipulation of the closed system; or if patient requires other IV Rx, we will often insert a PICC to achieve least manipulation to the TPN line. Hope this helps.

Barbara

kfarr
we stop TPN for one hour, is

we stop TPN for one hour, is this extreme ? when we draw labs we flush with 5cc and pull back 10cc for waste then our sample.

Karen

lynncrni
Yes, that is very extreme.

Yes, that is very extreme. Are you talking about a single lumen catheter or a multiple lumen one? How do you prevent clotting in that lumen when the flow is stopped. This is not supported by any evidence that I know of. I am curious about how this extreme length of time came about. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

lynncrni
In addition to accurate lab

In addition to accurate lab values, you must be concerned about the additional manipulation of the catheter hub and administration set. While disconnected, this set absolutely must be covered with a new sterile end cap. This can not be the tip cap from a syringe. Strict aseptic technique must be adhered to for both the set and the catheter hub. This technique should be validated in a documented competency. Using these lines for blood drawing should only be done is the rare situation where there is absolutely no other option for obtaining the sample. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Gina Ward
labs from TPN, and end caps

 

Lynn, 

 

I am so glad you mentioned not to use the end cap that was on a syringe.  I have found our staff is getting in the habbit of using the white cap that covers the end of the syringe used for our 10cc saline flush syringes to cover intermittent infusion sets.  They feel that they just took it off the syringe and hold it and place it on the end of tubings.  I too am concerned about the sterility in this.  I asked our nurse who orders supplies for the hospital to see if there is a sterile end cap to put on tubings when being disconnected.  ( She said that corporate said no, to use what we have).  I am sure there is a much cheaper alternative than using products that werent made for just capping off a line.   We only have the blunt needles, plastic cannulas or what we call gator clamps.  Any input or data on this??? 

 

Also,  Is it necessary to stop the infusion of TPN if you are drawing blood from a multilumen line and not the line with the TPN.  I thought since hemodilution was so significant in the SVC this wasnt necessary ( especially if you can give incompatible drugs in the different lumens)

 

Thank you in advance for your input.  Gina Ward R.N., CPAN

Gina Ward R.N., VA-BC

lynncrni
The tip cap on the syringe is

The tip cap on the syringe is a single use device. Once removed from the syringe it must be discarded and not reused for any purpose. If you had some lawsuits involving CRBSI, this would become an issue because you are using this in a manner outside the manufacturers recommendations. Tip caps should be purchased for covering the male luer end of the intermittent set and there are many companies that make them. This is a huge issue, in my opinion. We are so concerned about CRBSI and reaching zero. We are blaming the majority of the problem on needleless connectors, yet this is a 2 sided system. If you are attaching contaminated IV sets to the needlelless connector, it does not really matter how well it has been scrubbed. That contaminated set will introduce organisms.

I would recommend stopping the TPN infusion for at least one full minute before you draw a sample from the other lumen. Yes heomdilution is significant in the SVC, but you could have some of this infusing solution pulled into your sample and give an inaccurate value. TPN would alter the electrolytes and glucose especially. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

laurenb
 We have reports from our

 We have reports from our laboratory that report contamination of labs. The biggest event is the TPN with lipids. The lipids take longer to clear the atrium than other fluids/meds so we have gone to a 10 min turn off for any lipid containing infusion with good results.

 

 

Lauren Blough, RN, BS, CRNI, VA-BC
Clinical Development Manager
Biolife, LLC "Makers of StatSeal"

Gwen Irwin
Drawing labs through PICC with TPN infusing

I would agree that is extreme.

Here is how I think about the amount of time to have infusions off.  The volume of blood flow in the SVC is about 2000ml/hour for most adults.  By the time I can turn off infusions, disconnect the tubing, cover the tubing tip with sterile cap, clean the connector with alcohol, attach a syringe for waste blood, then draw the specimen, enough time has passed that the infusate is not still in the SVC.   Draw the required amount for the lab.

We have not had lab results impacted that we are aware of. 

Hope this helps.

Gwen Irwin

Austin, Texas

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