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kathybrn
PTTs drawn thru PICC and Pediatric waste

I'm reviewing policies and have 2 questions. 

For our patient's with PICCs (single or dual lumen) on a heparin drip, what is the "best practice" for drawing a PTT.  The patient in question had a PICC for access as peripheral access was an issue.  Could the same process for labs via PICC with  TPN infusing be utilized?

How much blood volume are you wasting for blood draws for adults and for pediatrics?

Thanks for your time and expertise.

Angela Lee
We do not get PTTs from any

We do not get PTTs from any catheter which has heparin infusing.   Waste for other labs is approximately 2 to 3 times the volume of the catheter.  We use very small catheters (peds) compared to adults.

lynncrni
Multiple studies have shown

Multiple studies have shown that drawing any coagulation tests from any CVC that has been in contact with heparin will produce altered lab values. So most policies state **not** to draw coags from any heparinzed catheter. Waste should be equal to 3 times the internal volume of the catheter and any ext sets added. 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
drawing labs from line with heparin

 

Why couldnt you draw the protime, aptt from the lumen that doesnt have the heparin running?

 These are totally seperate lumens that the fluid never makes contact with the fluid in other lines, that is why we can hang incompatible drugs in seperate lumens on a multilumen picc.  I do realize that the meds are then released in very close proximity, but then you have such a rapid volume of blood rushing through the svc to dilute it.   Those are just my thoughts, at our hospital most of the time they draw peripheral as well , just because they are leary.  

I have wondered  about drawing a baseline aptt one from peripheral and one from a non heparing lumen  at same time, and then compare to see the accuracy?

I am interested to hear some feedback.  Thanks,  Gina Ward R.N., CPAN

 

Gina Ward R.N., VA-BC

lynncrni
You could draw coags from a

You could draw coags from a separate lumen as long as no heparin has been used to lock or infuse through it. If you have heparin infusing through one lumen you would need to stop that heparin for at least one full minute before you draw those labs as there could be some mixing at the tip location. I think the studies I am recalling did not evaluate the use of draws from multilumen lines and I am not aware of any studies on blood sampling from multilumen lines. So we are basing this practice on expert opinion and manufacturer recommendations. 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

bcardin
We have been told by our Lab

We have been told by our Lab that using blood drawn from PICC's for PTT's give inaccurate results.  Do you have any information regarding this?

Bobbi Martin, RN

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