Taking Blood from a PICC Line? The Ultimate Guide!

Taking Blood Sample from PICC Line: The Ultimate Guide!

This guide provides a comprehensive overview of how to safely and effectively draw blood samples from a Peripherally Inserted Central Catheter (PICC) line. It is crucial to follow proper procedures to minimize the risk of complications such as infection, blood clots, or catheter damage. Always refer to your facility’s specific policies and procedures, and consult with a qualified healthcare professional if you have any questions or concerns.

Preparing for the Procedure

Before you begin taking blood from a PICC line, thorough preparation is essential. This includes gathering necessary supplies and preparing the patient.

Gathering Supplies

Ensure you have all the following items readily available:

• Personal Protective Equipment (PPE): Gloves, gown, mask (as required by facility policy).
• Antiseptic Solution: Chlorhexidine gluconate (CHG) or povidone-iodine.
• Sterile Gauze Pads: For cleaning and dressing the site.
• Sterile Saline Flush: Prefilled syringe(s) for flushing the catheter.
• Heparin Flush (if required): Prefilled syringe(s) for heparinizing the catheter (follow facility protocols).
• Syringes: Of appropriate size for blood collection.
• Blood Collection Tubes: Of the correct type and number as ordered by the physician.
• Transfer Device (if needed): For transferring blood from the syringe to the tubes.
• Catheter Clamp: To temporarily occlude the PICC line during certain steps.
• Sterile Caps or Luer-Lock Connectors: For maintaining sterility.
• Waste Container: For disposal of used supplies.
• Laboratory Requisition Form: Completed and ready to label the blood samples.
• Tourniquet: Only if taking blood from the arm with the PICC line, apply below the insertion site.

Patient Preparation

• Verify Patient Identity: Confirm the patient’s name and date of birth using at least two identifiers.
• Explain the Procedure: Clearly explain the steps involved to the patient and address any concerns they may have.
• Assess the Site: Visually inspect the PICC line insertion site for signs of infection (redness, swelling, drainage, pain). If signs of infection are present, notify the physician before proceeding.
• Position the Patient: Ensure the patient is comfortable and in a position that allows easy access to the PICC line.

Step-by-Step Procedure

Follow these steps carefully when drawing blood from a PICC line.

1. Hand Hygiene: Perform thorough hand hygiene by washing your hands with soap and water or using an alcohol-based hand sanitizer.
2. Don PPE: Put on the necessary personal protective equipment.
3. Prepare the Site: Clean the hub of the PICC line with the antiseptic solution. Use friction and allow the solution to dry completely (usually 30 seconds) before proceeding. Do not touch the hub after cleaning.
4. Attach the Syringe: Using aseptic technique, attach a syringe to the PICC line hub.
5. Withdraw and Discard Waste Volume:
   • Gently aspirate the initial blood volume (waste volume). This is the blood that remains in the catheter and may not be representative of the patient’s circulating blood. The amount of waste volume to discard varies depending on the PICC line size; check your facility’s policy for specific amounts. Usually, this is between 3-6 mL.
   • Clamp the PICC line.
   • Remove the syringe with the waste volume and dispose of it appropriately.
6. Attach New Syringe: Attach a new sterile syringe to the PICC line hub.
7. Obtain Blood Sample:
   • Unclamp the PICC line.
   • Gently aspirate the required amount of blood for the ordered tests.
8. Stabilize Blood: Invert the blood collection tubes gently several times to mix the blood with the anticoagulant (if applicable).
9. Flush the Catheter:
   • Attach a pre-filled saline syringe to the PICC line hub.
   • Unclamp the PICC line.
   • Flush the catheter with saline using a pulsatile (start-stop) motion to ensure thorough cleansing. The amount of saline used should be based on the catheter size and facility policy.
   • Clamp the PICC line.
   • Remove the Saline syringe.
10. Heparin Lock (If Required): If required by facility policy and physician orders, administer a heparin flush using the same pulsatile technique as with the saline flush. Clamp the PICC line and remove the Heparin syringe.
11. Secure the Hub: Replace the sterile cap or Luer-Lock connector on the PICC line hub.
12. Dispose of Supplies: Safely dispose of all used supplies in appropriate containers.
13. Remove PPE: Remove your personal protective equipment and perform hand hygiene again.
14. Label Samples: Immediately label all blood collection tubes with the patient’s information, date and time of collection, and your initials, according to the laboratory requisition form.
15. Transport Samples: Transport the blood samples to the laboratory promptly.
16. Document Procedure: Document the procedure in the patient’s medical record, including the date and time of collection, the amount of blood drawn, any complications encountered, and the flushing solutions used.

Troubleshooting Common Issues

While following the procedure diligently is crucial, troubleshooting can sometimes be necessary.

Difficulty Aspirating Blood

If you encounter difficulty aspirating blood, consider the following:

• Check for Kinks or Clots: Examine the PICC line tubing for kinks or obstructions. Attempt to gently flush the line with saline (if not contraindicated).
• Reposition the Patient: Have the patient change positions (e.g., turn their head, raise their arm) to see if this improves blood flow.
• Reposition the Catheter (by qualified personnel): If the above measures fail, a physician or qualified nurse may need to reposition the catheter slightly.
• Do NOT Force: Never force aspiration or flushing, as this could damage the catheter or cause a clot to dislodge.

Blood Clot Formation

If a clot forms within the catheter, do not attempt to flush it with force. Follow your facility’s protocol for clot management, which may involve the use of a thrombolytic agent.

Infection Control Concerns

If you suspect the PICC line site is infected, immediately notify the physician. Do not attempt to draw blood or flush the catheter.

Table: Recommended Flush Volumes

This table provides general guidelines for flush volumes. Always refer to your facility’s specific protocols.

Catheter Lumen Size	Saline Flush Volume (mL)	Heparin Flush Volume (mL)
Single Lumen	5-10	2-3
Double Lumen	5-10 per lumen	2-3 per lumen
Triple Lumen	5-10 per lumen	2-3 per lumen

Disclaimer: This guide is intended for informational purposes only and does not constitute medical advice. It is essential to follow your facility’s specific policies and procedures and consult with a qualified healthcare professional for any questions or concerns related to taking blood from a PICC line. Improper technique can lead to serious complications.

And there you have it! You’re now armed with the knowledge to tackle taking blood sample from picc line with confidence. Just remember the key steps, and you’ll be a pro in no time!