We were having a debate at work today about using Vacutaners to collect blood for lab draws from a Picc. I told the nurses I would post a question here and see what expert advice I could get! Does it pose a threat to the integrity of the Picc? I personally like to use a 10 or 20 cc syringe to collect the blood for labs etc. Thank you all in advance.
Vacuum tubes are not known for causing permanent catheter damage. The negative pressure inside them can easily cause a PICC to temporarily collapse, occluding the backflow of blood. Once you disconnect and flush, the lumen is open again. Your use of a 10 or 20 mL syringe can create negative pressure higher than the vacuum tubes though. On aspiration, larger syringes created greater pressure due to the larger surface area to hold on to and the fact that you can pull harder with them. This is the opposite for injection where larger syringe generate less pressure. Use of a vacuum tube system is far better because it eliminates having to transfer the blood from syringe to the tube. You must have a needleless transfer device for this process. You should never make this transfer using a needle or remove the cap from the tube to squirt the blood into the tube. Removing and replacing the cap can cause the tube to break inside the machines in the lab, and clean up will expose the lab staff to blood exposure. Using needles for this transfer has a great chance of causing a needlestick injury and I have heard presentations from nurses who did that, got hepatitis and required a liver transplant. So vacuum tubess are safer in my opinion.
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
Thankyou very much for the info!!
In addition to Lynn's great response, you can check the PICC manufacturer's IFUs (for instance, the Power PICC Solo Nursing Guide describes both the vacutainer and syringe method for blood sampling).
Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada
Our facility uses the stopcock method to draw blood from a PICC.
The stopcock is attached, a 3 mL syringe is opposite, and the vacutainer is at the 90-degree angle with the stopcock off to the vacutainer. Blood is drawn into the syringe from the PICC, then turn the stopcock off to the PICC and the blood drawn into the tube/vacutainer from the syringe. The first tube is a waste, then each tube is filled the same way by flipping the stopcock off to the vacutainer, then PICC, etc. In this way you only attach once to the PICC with the stopcock. It saves the on and off for each syringe and avoids blood transfer into each of the tubes.
Carole
Thankyou Carole, that sounds brilliant. I will try it this morning!!!
Lynn is correct in that the vacutainer tubes have a preset vacuum that allows for the proper volume of blood to be aspirated into the tube. This issue with PICCs or any CVC is that the transfer of this withdrawal pressure can cause difficulty with success. The syringe method allows the nurse to control withdrawal pressure and even vary it throughout the process. When a syringe is used with a transfer device and I recommend a luer device and not a slip tip device, blood exposure is minimized. I used to draw blood samples from CVCs every morning and I found that the syringe method offered the most consistent result. When the vacutainer works well it is quick and easy. But I found that it was not as reliable as the sryinge method. Using a transfer device allows the preset vacuum to pull the exact amount of blood into the tube. Lynn is also correct, if you are having difficulty using a 10 mL syringe drop down to a 5 mL syringe and you will probably be very successful. The decision is really made by the succss of the draw. Because of the ease of use of the vacutainer it is often the first choice. If you do not mind switching to a syringe if not successful, then there are not guidelines against it.
Denise Macklin