Forum topic

I agree with Lynn.  We had a nurse refuse to draw labs from an implanted VAD in a patient who specifically requested it.(primarily due to lack of knowledge on how to do it).  The patient complained - rightfully so - and suddenly policies were changed to say that "ALL patients with a central line WILL HAVE lab work drawn from them".  As coordinato of the PICC service, I objected and was overruled but have seen a huge increase in clotted PICCs.  We are working to change this policy and I have developed a teaching tool for patients to read that gives the pros and cons of having their labwork drawn this way, and ask that the patient make an informed decision.

I have absolutely NO problem using the PICC for a blood draw if: 1) the patient requests it after reading the info, 2) there are no peripheral sites to get blood from, or 3) if the patient is needle-phobic, such as peds.  I would be happy to emai the teaching sheet we developed if that would be helpful to anyone.  Wendy

We do allow blood sampling from lines at our hospitals unless the physician orders otherwise.  Our patient population is primarily geriatric and it is often an advantage for them due to frequent testing.

It is also a challenge to educate nurses to do this properly, monitor technique and results, etc. 

Pretty much everything we do requires a risk-benefit analysis.  I believe it can be done safely and effectively, but there are definitely risks.

I agree it is a risk benefit analysis but I would draw labs from central lines.  Here are the reasons to do so:

Decreased multiple peripheral venipunctures with the risk of nerve injury, compartment syndrome, yes infection (we take peripheral puntures too non-seriously because we do not indeed know if they contribute to infection overall), patient comfort, better Press Ganey scores for venipunctures, Patient satisfaction, obtaining enough sample to be tested.  We take the usage of multiple peripheral venipunctures so lightly.  I for one do not like needlesticks as they are painful.  Call me a wimp but I am one of the future patients

Did you ever see a patient all bruised up and the venipuncture sites hurt worse than the major surgery they had?

Occlusion is primarily but not always a nursing error or complication as a result of poor education and never should be considered a reason not to draw labs from a central line

Blood loss should be consisdered.  Infection risk is also related to care (proper flushing and proper sample drawing).  I do not think it is acceptable to allow poor care issues to dictate whether a patient should have peripheral blood draws or central line blood draws

As for your doctor he probably read that taking blood samples from a central line increases infection (related to poor care once again) and results in inaccurate lab values (related to poor care i.e. blood draws)

I believe there has been several article in the past few years about blood  collection from diffrent VADs.   One article was by Linda Farjo, RN in the Nov/Dec issue of Jourlnal of Infusion Nursing.

§         Frey A. Drawing blood from vascular access devices: Evidence-based practice. Journal of Infusion Nursing. 2003;26(5):285-295.

Nancy Moureau, BSN, CRNI

PICC Excellence, Inc

[email protected]

I wonder about the 5 minutes being in policy.  Based on the blood flow rate in the SVC, 5 minutes seems to be a long time.  With multi-lumen catheters with infusions by the time you turn off everything and get ready to do the lab draw,  all of the medications infused should be gone.

With evidence based practice leading the way, what is his evidence? 

Gwen Irwin

Wendy

I would appreciate a copy of your teaching tool . [email protected]

Nadine: would you be willing to share your competency form with us? [email protected]

Thank you all

Wendy,

Could you please email the patient decision tool to me at:

[email protected]

Thanks so much for sharing

Trish

Wendy,

I had asked earlier if you could share the teaching tool, but never received.  If you wouldn't mind, could you please email to:

[email protected]

Thanks

Trish

   Our facility (lab) has been doing a study on lab values from PICC's for over a year now, and they have come to the conclusion (not published yet) that the values, even compared to other central line draws, are VERY off from those drawn peripherally.  They tried last summer to ban lab draws from PICC's, but we came to a "meet in the middle" by agreeing to not place any PICC's for lab draws alone.  We also let the doc's know that they need to recheck the values if they seem abnormal when drawn from a PICC.  I do not know the specifics from the study, but I have been assured that it will be published when they are done.  I will keep you all posted.

Heather

I drew a CBC and CMP from a groshong PICC once and  Lab techs questioned the values.  Within the same hour a peripheral sample from the other arm was obtained. The results?  Almost a complete IDENTICAL match. I haven't participated in any research on this subject, but in this one patient the PICC lab values were accurate. I would hesitate to say this should never be done. Saving patients from unneeded needle sticks is huge in the vascular access world.