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Jackie Tropp
PICC Questlons

When PICC lines are inserted do people get a specific order OK to use or do they check out the x-ray result and if it is the SVC just use it?  

What is the policy around the country with regards to a patient with a central line being readmitted, do they automatically get a chest x-ray to verify position.  How is it written in the policy?  

Do nurses routinely draw blood from PICC lines using a vacutainer system? 





Jackie Tropp
Jackie Tropp RN, BSN, MSN,
Jackie Tropp RN, BSN, MSN, CRNI

Jackie Tropp RN, BSN, MSN, CRNI

Angela Lee
I verify placement with a

I verify placement with a radiologist and then clear the line for use.

Our NICU does weekly CXRs to check PICC placement.  I have not done that with other patients or on patients that come in with PICCs but I think it is a practice I will start.  I am finding that apparently everyone's definition of a PICC is not the same.   I have had several patients transferred to us from other facilities with a  "PICC" that is nowhere near the SVC. 

We do not withdraw blood from our PICCs with vacutainers-they are too small and the walls of the catheter would collapse.

Our hospital does not have a
Our hospital does not have a specific policy re: readmission x-rays but I highly encourage it. Recently we had a pt. admitted with a PICC line.  The line was sutured in so I pretty much figured it was placed by IR in another facility, but I encouraged staff to get an x-ray.  Lo and behold the tip was in the axilla!  The story gets better.  I rec'd an order to go ahead and do an exchange to place a full PICC.  Well,  as soon as i got to the axillary area, I could not advance. Come to find out the pt had a thrombus in that vein which is why the IR docs couldn't get in but they just left it in the axilla!!!
We place an order on the
We place an order on the chart after the PICC is in place which the doc signs. That covers the stat portable CXR, flushing orders, dressing changes and that they may use the line if verified to be in SVC or atrial caval junction. This works well for our team.

Cindy Hunchusky, BSN, RN, CRNI

I have drawn blood from
I have drawn blood from PICC lines using a vacutainer mostly in homecare and have had no pxs with hemolysis or others. Haven't seen this much in the hospital, don't think alot of staff nurses know how to do it from my experience. These are from 4,5 and 6Fr catheters. Haven't much experience with peds though.

Cindy Hunchusky, BSN, RN, CRNI

Karen Day
Karen Day's picture
in our facility, we place a

in our facility, we place a sticker on the chart with the exact wording/interpretation of the tip placement by the Radiologist so that there can be no mistake where the tip is. 

I am also working with my facility to x-ray every patient admitted with a PICC/Central Venous Access device as I have seen many problems (i.e a port that was broken and lodged in the pulmonary artery in an asymptomatic patient; midline catheters exteriorly labeled as a picc and the list goes on).  While there has been many concerns over the cost involved in x-raying these patients, I try to remind them that it will only take one patient with a malpositioned catheter or device that we as nurses infuse through without checking and cause a sentinel event---how will that stand up in court.

As for the vacutainers, I prefer not to allow this on our picc lines and recommend pulling your specimen with a 10cc or larger syringe.




On aspiration, larger

On aspiration, larger syringes cause MORE pressure - the opposite from injection. So a 10 ml syringe can cause the same or more temporary occlusion as a vacuum tube system.  


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

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Angela Lee
Lynn is correct--I had to

Lynn is correct--I had to explain to our nurses that you do not want to use a 10 ml syringe for blood withdrawal but instead use the smallest syringe possible that will hold the volume needed.  I think I am one of the few people willing to draw from 1.9 Fr PICCs and I go down to a 1 ml and never larger than a 3ml syringe. Of course we can do CBCs and renal panels on .5ml or less. The larger the syringe the longer it takes  and the greater chance of blood cell occlusion (for our small catheters) with the slower withdrawal.  If the volume needed is several mls I may be more likely to do a venipuncture than have to go back and tPA the line.

Obviously when you're working with 5 and 6 Fr PICCs there is less risk of an occlusion (blood cell) but the pressure issue remains.

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