I have always been taught not to use vacutainers with PICC lines and instead use syringes for blood sampling secondary to cell lysis and clotting issues. I have been reading online that manufactuers are promoting the use of the vacutainer. My concern is that the nurse does not know the size of the catheter, when to use or not use, confusing Power PICCs and Groshong PICC line makeup (being valved vs not valved).Â
I would like feedback on what others are currently practicing.....please.
ejr67, VAMC
We are changing to a device for vacutainer CVC lab draws. I am not concerned about using them on PICCs. I would think that the negative pressure from a vacutainer is more consistent than someone using a syringe and pulling back really hard, thus creating more negative pressure. Someone pulling back on a syringe lightly would create a different negarive pressure.
However, once this change has been implemented for us, I might have a different answer.
Anyone using vacutainers with PICCs? Please let us know what your results have been.
Gwen Irwin
Austin, Texas
I would too appreciate any feedback on what others are using as I have always been taught not to use them. My personal experience has been a nurse used it once 1 hour after i placed a PICC line and not only lysed the blood but clotted off the line. It was a 4 Fr Groshong. My question is, a lot of nurses do not flush prior to drawing their waste and check for blood return. They attach the vacutainer up to the PICC and waste a tube then draw their sample. They then call and say they can't get a blood return.
Another question would be, does it depend on the type of PICC? I know that Power PICC's are more agile and Groshong's are more prone to collasping.
Thanks,
ejr67
Using a vacuum tube system to obtain a blood sample on a PICC is acceptable practice and provides many benefits. It does not cause damage to the RBCs or the catheter. The negative pressure can cause the PICC to temporarily collapse thus occluding the backflow of blood. But there is no permanent catheter damage as the catheter will return to the original shape when the negative pressure is removed. The vacuum tubes will provide a consistent amount of negative pressure while the syringe pressure could vary depending upon the size, strength and technique of the hand that is doing the procedure. Drawing directly into the vacuum tubes eliminates the need for transfer of the blood from syringe to the tubes. If you choose to use the tubes, then you absolutely must have a transfer device that is designed to prevent needlestick injuries. You can not do this transfer with a needle on the syringe. And you should not remove the rubber stopper on the tube to do the transfer either.
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
Vacutainers are an appropriate method for blood sampling from PICC's as well as the syringe method. Lynn is correct regarding consistent pressure and safety.
Remember an open ended catheter may have a proximal valve, if the valve opens and closes due to pressure, then as the vacutube fills the amount of pressure decreases. This may result in vacutubes not 100% filled, usually significant with certain lab tests, i.e. PT/PTT.
Great question, great responses.
Timothy L. Creamer, RN
Clinical Specialist, Bard Access Systems
Florida Division
Timothy L. Creamer RN, CRNI
Clinical Specialist, Bard Access Systems
Florida Division