We do a lot of PICC line care for patients having chemo. Sometimes the Chemo units ask us to take bloods, generally because the patient has very few veins left that can be accessed.
Is there a method of using the vacutainers without breaking the sealon the phials?
Is it ok to use a syringe to withdraw the blood and then use a needle to access the vacutainer? does this work?
If using the same system used for a bung, does the positive pressure bung and the end of the vacutainer needle device form a secure seal ie low possibility of accidental disconnection, bearing in mind these people have been having chemo at home
I am an RN in the United States, with a CRNI, a national certification in Infusion therapy by the Infusion Nurses society (INS) and I am active in the Association for Vascular Access. Both of these professional organizations welcome international members, and set the standards of care for vascular access and infusion. You can research more at www.ins1.org and www.avainfo.org
Regarding your PICC line question: Yes, you can draw blood from a PICC line. You will be most successful if the PICC line is 4FR or larger. 3FR and smaller lines are very difficult to draw labs from and clot easily. The procedure is: stop anything infusing, flush the line with 2-3x the lumuen of Normal Saline (at least 5mL)using a 10mL or larger syringe. Slowly, VERY Slowly, withdraw a waste sample of at least 2-3x the lumen of the line(at least 5mL). If you cannot get a blood return, try a 5mL syringe. Attach a new 10mL (or 5mL) syringe, and draw your sample. Then flush your PICC line with 10-20mL of Normal Saline, using at least a 10mL syringe. You can then transfer your blood sample into your vaccume tubes either with a blood transfer device (needless) or a 18G or larger needle. A smaller needle may hemolyse the sample. Hope this clears up the confusion.
The advice about the size of the needle is particually welcome
Hi there, I'm a haematology nurse in manchester, and have a lot of experience with many types of line, and have worked as an IV trainer previously.
with regards to bleeding PICCS, it's common practice for me. basically you need to treat it as any other central line. Ideally you'll be using the picc with a bionecter or other similar needle free injection port. the line may need to be flushed first with 10ml of saline using the pulse flush technique - inject 1 ml, wait 1 second and so on. most of the time this may not be needed. then with the vacutainer, the easiest way is to use the blue needle free adaptor that connects it to a luer connection. attach the blue adaptor to the vacutainer holder, and attach this to the bionecter. then if you attach an empty tube to this it should bleed back on the vacuum, but the tube needs to be a big one in order to clear the flush from the line (a gold top is usually enough, but may need another one) discard this, click in the tubes you need, and then disconnect the vacutainer holder and adaptor from the bionecter, and flush the line like before. before accessing the line it should be cleaned thouroughly with a 70% isopropanyl alcohol and 2% chlorhexidine wipe as recommended in the EPIC 2 guidelines. the idea behind using the extra bottle(s) is that you minimise the number of line accesses(i.e. only once to withdraw waste, and sample then once to flush rather than with a syringe once to remove waste, once to sample, and once to flush) so hopefully it means 2 accesses not 3. If the vacuum does collapse the line, then it's bad luck, but you'll need to use a 10ml syringe and draw slowly. in terms of then transferring this to the bottles, DO NOT PUT A NEEDLE ON THE END OF THE SYRINGE AND TRANSFER IT TO THE BOTTLES LIKE THAT!!! this is very bad practice, as it is a huge risk of a needlestick injury. you should either flip the top off the bottle and squirt it in slowly up to the required vollume then push the lid on firmly or even safer is to get a 3 way tap, connect it to the blue luer adaptor attached to a vacutainer holder, and attach the syringe to another port on the 3 way tap. set the tap to flow between the 2, and just click the bottles into the vacutainer holder.
hope that helps, let me know if you need more info
adam mccavery (RN, BNhons, MSc)
Thanks Adam, I hadn't thought of using a tube instead of a syringe to clear the dead space and as you say it reduces the number of accessing times. We will be reviewing our protocols soon and we will need to consider this idea. I guess we should also look at any cost diference between syringe and tube.