INS Standard states that labs shouldn't be routinely obtained this way. However, if it does become neccessary then it should be a designated line and only used for 48 hrs. Not using the line for anything other than labs makes sense secondary to contaminated specs although we use CVC's/PICCs in this manner. Also, there is an increased chance of infection with a lock in vs the venipuncture. What's the point of "48hrs"? Don't get me wrong...I know it's not good routine practice but in one breath INS states it may be neccessary and in the next warn that you shouldn't do it for more than 48 hrs. What's that all about? If the patient is very difficult and requires frequent lab draws I'm certainly not going to put in a PICC for labs and really put the pattient at risk. This seems like just one more case of an INS Standard that has not been thought through.Â
Oh but we did think this one through completely. I am a little prejudice but I know how much thinking and work went into updating this document. So we do think things through. This 48 hours is given as an example of short term use of a peripheral IV catheter. This will occur in some patients who have certain protocols for having lab work drawn frequently such as every hour for many hours. This was placed in the document to accommodate the needs of these patients, many of whom are pediatric patients. If you patient needs frequent blood samples, don't they also need infusions? What patients are you seeing that need only frequent blood sampling without the need for any type of IV fluids or meds? What exactly do you mean by "frequent"? A peripheral catheter in a small peripheral vein will just not withstand frequent blood sampling for extended periods of time. So I think you should look at the entire patient needs and rethink your prohibition on a PICC in some of these patients.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
I have a specicic scenario in mind that happens here frequently. Patients on heparin with every 4 hr lab sampling. The patient with very difficult access that we believe really needs an additional 22 ga piv for lab sampling. These catheters draw very easily and EASILY last for 4 days. Hence, my question, Lynn...why 48 hrs?
I would not place a PICC when I could do this.
Also, I apologise for the way i posed the question. It isn't fair without hearing the explanation/rationale for a few other things I question in the Standards.
Maureen Lawler CRNI
Clinical Leader Venous Access Team
Salem Hospital
North Shore Medical Center
Salem, Ma 01970
The 48 hours was based on the common practices for those protocols for frequent blood draws. I see nothing in the standards that would prohibit you from using a PIV for longer than 48 hours for lab draws. Carefully read the wording. The 48 hours was given as an example, not as a restriction. Standards are not the same as procedures, so this is not intended to restrict it to 48 hours. I would ensure that the PIV was in the opposite extremity from where the heparin is infusing, just to be sure that you are not getting a sample from anywhere near the infusing vein.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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