Questions for the group; I am interested in evidence or articles to back up the schools of thought on these statements.
thanks, in advance
1. why do a large majority of people say to not use a vaccutainer/blood transfer device on a picc line? We have not found any issues with hemolysis of blood when used, nor have we noted occlusions or catheter issues as a result?
is there any evidence to back this up?
2. why do they say to not use the PICC arm for blood draws or bp or any other ivs?
i would imagine it is to reduce any further vein irritation, however some times due to limiting issues such as the opposite arm is the mastectomy site, fractured, wounded etc.....we then use the lower portion of the the arm for bp or even the hand for an additional peripheral iv
any evidence to validate this stance?
thanks in advance, Gina Ward R.N., VA-BC
I am not sure who you means by "they say".
A vacutainer on a PICC could exert a high negative pressure sufficient to collapse the lumen and prevent blood from drawing. No permanent damage to the PICC though. If this happens you will need to change to drawing with a small sized syringe like a 3 or 5 mL.
Using veins on the same extremity in the hand or lower forearm well below the PICC site is acceptable if there is no other location. BP in the wrist is also acceptable if there is no other choice. What personnel are making these decisions? For BP in wrist, that depends on availablility of a suitable cuff for that site. For venipuncture, this should be restricted to hand and lower forearm and a phlebotomist from the lab or other unlicensed personnel may go too high on the arm. Damage to vessels and nerves near the PICC insertion site could increase risk of complications.
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
Thank you for your response Lynn.
Many other facilities are "saying" those things. I agree with your responses and practice in accordance to that same school of thought.
Gina Ward R.N., VA-BC
It's like you were reading my mind! I signed on today to specifically ask about this issue. We also have had recent questions about this. The facility I work in DOES NOT use vacutainers on our PICC and Midlines for the reason you mentioned Lynn. We are getting push back from other sister hospitals in our health system though that we should change our policy because it is outdated.
While a vacutainer COULD cause a temporary collapse of a PICC, I don't think that is a reason to avoid using a vacutainer. Drawing directly into a vacutainer prevents the need to transfer blood from the syringe into the vacutainer. Do you have needleless transfer devices? If not, there is simply no acceptable way to transfer the blood into the vacutainer. Using a needle for this purpose is documented to have cause HBV in some nurses. You cannot remove the tube top to transfer because that can lead to tube damage in the lab equipment. I would first recommend getting away from using all CVADs for blood draws as much as possible. See INS Standards on Phlebotomy re this issue. If there are no other choices, then use a vacutainer first from a CVAD and change to a syringe only if the vacutainer does not work. 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
Yes, we do have vacutainer devices for both direct attachment to the hub, and syringe. Thankfully, we did get them away from needles/blunt cannulas a few years ago. Unfortunately, we have not gotten away from using CVADs for blood draws except in specific circumstances. We don't worry so much about PICC collapse as we do Midline collapse. We still have a LARGE learnig curve in regards to flushing and use/care of these devices. Baby steps.
Yes, we do have vacutainer devices for both direct attachment to the hub, and syringe. Thankfully, we did get them away from needles/blunt cannulas a few years ago. Unfortunately, we have not gotten away from using CVADs for blood draws except in specific circumstances. We don't worry so much about PICC collapse as we do Midline collapse. We still have a LARGE learnig curve in regards to flushing and use/care of these devices. Baby steps.