How to draw blood from a PICC line

When drawing blood from a double lumen PICC line, which has TPN running do you

1/ Flush with 10mls of normal saline, pull back 10mls of blood discard and throw that away before taking your sample.

2/ Turn off TPN and wait for 30 mins and then draw blood, after having flushed with normal saline, drawing back, throw first sample away and then take a second sample.

3/ Draw the blood without flushing


4/ Turn off TPN, immediatly flush the line, draw blood, discard first specimen and then take a second sample.

5/ None of the above-explain
Our policy for blood draws from a PICC was to stop any IVF infusing, flush the lines with 10cc of saline, withdraw a waste, withdraw the sample, then flush with 20cc of saline before starting the fluids again. If TPN was infusing, we flushed with 20cc of saline beforehand. When I left, they were re-writing the policy to delete the step of flushing prior to the waste.

So what is the answer for sure? Maybe I am missing it.

Anyone?

Some of our patients get q2h blood draws. I would never get the TPN in if I stopped it for 30 minutes every time I needed to draw blood, and my patients' blood sugars would be a mess. The whole point of stopping, clamping, and drawing a waste is that you're getting their blood, not what's infusing.

Draw from other port.Flush with 10 cc NS, waste, draw sample and flush with 20 cc NS

Stop TPN, flush and clamp lumenFlush 2nd lumen with 10mlWaste 10mlDraw labs Flush again with 10mlUnclamp and resume TPN

TPN must always run through a dedicated port. The TPN should be stopped for a minute. Flush the other lumen with 10cc of saline and confirm blood flow with your flush syringe and actually draw your 10cc waste back in that same syringe. Draw your sample and flush well with 20cc of saline.

I would basically do what annister did. 1) Stop and cap TPN or pause and clamp tubing.2) Clean both ports. Flush both ports with 10 cc syringe3) On port that wasn't being used for TPN withdraw waste (10 cc).4) Draw labs.5) Flush with 10 cc syringe or 20cc (there is no protocol for which on my floor)6) Restart TPN.

I use to think we stopped TPN for 30 minutes until I read hospital policy on this a week ago. I understand all hospital policies are different. Ours states to stop TPN for 5 minutes. Flush all ports with 10 ml NS. Draw 10ml waste. Draw blood with empty 10 ml syringe and transfer device. We then flush every port with 2- 10 cc NS syringes in a pulsating motion. We always leave 1 ml of NS in the last flush for a total of 19 cc's per port. I had a patient going into fluid overload last week on TPN,Lipids,and NS. I called the doc to get orders. Our policy states to never stop TPN abruptly and if you do so then to hang d10 at the same rate as the TPN and monitor for hypoglycemia. Not sure if that is the same everywhere. I just wonder how long TPN can be stopped before d10 needs to be hung.

Isn't this just a "Follow Facility Policy"?Stop infusion. Pick a non-TPN or non-heparin port if you can. Flush Draw Discard Draw Flush. Restart.If you have to use a TPN or heparin infusing line, flush with 20 first. Easy Peasy. Japaneasy.

Our policy is to stop TPN for 15 min., flush 20cc, draw 10 ml. waste, draw sample, change hub and flush with 20cc.

We don't stop TPN at all. You clean and flush your second port with 10ml Saline, draw and waste ten of blood, then with clean syrenge draw the amount of blood needed from lab. Then flush with 10ml of saline and then loc with 3ml of Heparin. Thats my biggest point is Hep lock after each use. These picc lines are so important but it seems as thow nurses forget to flush and hep lock. Then we have to depend on Cath flo to fix, which is crazy.We Hep Lock our Central lines with 5 of Hep. This is all part of our policy.Cris