How To Draw Blood From A Picc Line

Drawing blood from a peripherally inserted central catheter (PICC) line is an essential nursing skill. PICC lines are long, thin tubes that are inserted into a vein in the arm and threaded up to the superior vena cava, a large vein near the heart. They are used to administer medications, fluids, and blood products, and to draw blood for laboratory testing. Drawing blood from a PICC line can be done safely and effectively by following the proper steps.

Before drawing blood from a PICC line, the nurse must first verify the patient’s identity and the order for the blood draw. The nurse should then gather the necessary supplies, including a tourniquet, gauze pads, alcohol wipes, a syringe, and a blood collection tube. The nurse should also wear gloves and a gown to prevent the spread of infection.

Once the supplies are gathered, the nurse should explain the procedure to the patient and obtain their consent. The nurse should then position the patient in a comfortable position and apply a tourniquet to the arm above the PICC line. The nurse should then clean the insertion site with an alcohol wipe and allow it to dry. The nurse should then hold the syringe in one hand and the blood collection tube in the other hand. The nurse should insert the needle of the syringe into the PICC line and aspirate the blood. The nurse should then transfer the blood to the blood collection tube and remove the needle from the PICC line. The nurse should then apply pressure to the insertion site with a gauze pad and remove the tourniquet.

Gathering Equipment and Preparing Materials

The initial step in drawing blood from a PICC line is gathering the necessary equipment and materials. To ensure a smooth and successful procedure, it is essential to prepare all the required items meticulously.

### Essential Items

Syringes: Select a 10-mL syringe for collecting the blood sample and a smaller syringe (3-mL or 5-mL) for injecting saline flush before and after the blood draw.

Needles: A 22- or 23-gauge butterfly needle or a blunt-tipped Huber needle is typically used to access the PICC line.

Alcohol swabs: Alcohol swabs are used to clean the injection site and the PICC line hub.

Gauze pads or cotton balls: These are used to apply pressure after the blood draw or to absorb any spilled blood.

Tape: Tape is used to secure the butterfly needle or Huber needle during the blood draw.

Blood collection tubes: The tubes should be labeled with the patient’s information and the type of blood sample being collected. Ensure that the tubes are vacutainer tubes for proper blood collection.

Saline flush: Saline flush is used to clear the line before and after blood collection to prevent clots and maintain the patency of the PICC line.

Personal protective equipment (PPE): Gloves and a mask are essential for infection control during the blood draw procedure.

Item	Quantity	Purpose
10-mL syringe	1	For collecting blood sample
3-mL or 5-mL syringe	1	For injecting saline flush
22- or 23-gauge butterfly needle or blunt-tipped Huber needle	1	For accessing PICC line
Alcohol swabs	Several	For cleaning injection site and PICC line hub
Gauze pads or cotton balls	Several	For applying pressure or absorbing blood
Tape	1 roll	For securing needle
Blood collection tubes	As needed	For collecting blood sample
Saline flush	1 vial	For clearing PICC line
Gloves	1 pair	For infection control
Mask	1	For infection control

Establishing Correct Patient Identification

Accurate patient identification is crucial to ensure the correct patient receives the appropriate care. To establish correct patient identification, follow these steps:

**1. Check the Patient’s Identification Band:**

Verify that the patient’s name, date of birth, and medical record number match the information on the identification band.

**2. Ask the Patient to State Their Name and Date of Birth:**

Ask the patient to verbally confirm their name and date of birth.
If the patient is unable to communicate verbally, refer to the patient’s chart or medical records for confirmation.

If there are any inconsistencies between the patient’s stated information and the identification band or medical records, verify the patient’s identity using additional identifiers such as a photo ID or fingerprints.

**3. Compare Physical Characteristics:**

Note the patient’s general appearance, including height, weight, and facial features.
Compare these physical characteristics to the patient’s medical records or a photo ID to ensure they align.

If there are any discrepancies between the patient’s physical appearance and the recorded information, further investigation may be necessary.

**4. Document and Repeat Verification:**

Document the patient’s identification and the methods used for verification.

Periodically repeat the verification process, especially when administering critical medications or during high-risk procedures.

Adhering to these steps helps ensure accurate patient identification and reduces the risk of errors that could compromise patient safety.

Accessing the PICC Line

Accessing a PICC line is a relatively simple procedure that can be performed by a trained healthcare professional. The following steps outline the process:

Preparing the Patient

1. Explain the procedure to the patient and obtain their consent.
2. Position the patient comfortably in a seated or reclining position.
3. Clean the access port with an alcohol swab and allow it to dry.

Connecting the Syringe

1. Attach a 10-mL syringe to the access port using a luer lock or adapter.
2. Open the clamp on the syringe and gently aspirate to remove any residual blood.

Drawing the Blood

1. Hold the syringe steady and pull back on the plunger to draw the desired amount of blood.
2. Once the blood is drawn, close the clamp on the syringe and remove it from the access port.
3. Invert the syringe and gently tap on the barrel to remove any air bubbles.

Recommendation	Reason
Use a 10-mL syringe or larger	To avoid creating excessive pressure in the PICC line
Aspirate gently	To prevent damaging the blood cells
Invert the syringe after drawing blood	To remove air bubbles that could interfere with test results

Applying Tourniquet and Cleaning Insertion Site

Before drawing blood from a PICC line, it is crucial to prepare the insertion site and apply a tourniquet. Here’s a detailed guide to ensure proper preparation:

Applying Tourniquet

1. Select a suitable tourniquet, such as a blood pressure cuff or elastic band. It should be wide enough to fit comfortably around the patient’s arm.
2. Position the tourniquet approximately 3-4 inches above the insertion site.
3. Securely wrap the tourniquet around the arm, ensuring a snug fit. Avoid applying excessive pressure to prevent discomfort or injury.
4. Elevate the patient’s arm to promote venous filling and make the vein more visible.

Cleaning Insertion Site

1. Gather necessary supplies, including alcohol wipes, gauze pads, and gloves.
2. Put on gloves to maintain sterility.
3. Clean the insertion site with an alcohol wipe in a circular motion, starting from the center and working outward.
4. Allow the alcohol to dry completely before proceeding.
5. Use a gauze pad to gently cleanse the insertion site with sterile water or saline.
6. Pat the area dry with a clean gauze pad.

Material	Use
Tourniquet	Applies pressure to blood vessel above insertion site
Alcohol wipes	Disinfects insertion site
Gauze pads	Cleanses and dries insertion site
Gloves	Protects against contamination

Collecting and Handling Blood Samples

Materials:

Clean gloves
Alcohol swabs
Sterile gauze
Tourniquet
Blood collection tubes

Procedure:

Gather materials: Collect all necessary materials before starting the procedure.
Prepare the patient: Explain the procedure to the patient and position them comfortably. Apply a tourniquet to the arm 3-4 inches above the PICC line.
Cleanse the site: Use alcohol swabs to cleanse the injection area and allow it to dry completely.
Access the PICC line: Attach a sterile extension tubing to the PICC line.
Draw blood: Collect the blood sample according to the number and type of tubes required.
Apply pressure and remove the tourniquet: Apply pressure to the injection site for several minutes to stop bleeding. Remove the tourniquet and allow the blood to flow back into the vein.
Collect and handle the blood: Transfer the blood samples into the appropriate tubes and label them clearly. Store them according to the specific requirements for each test.

Blood Drawing Considerations:

Volume: Determine the exact volume of blood required for each test.
Additives: Ensure the correct blood collection tubes are used to preserve the blood samples.
Timing: Collect blood at the appropriate time in relation to the patient’s condition or treatment.
Labeling: Label the blood collection tubes clearly with the patient’s name, date, time, and type of sample.
Handling: Transport the blood samples to the laboratory promptly and handle them according to established guidelines.

Tube Type	Additive	Purpose
Red top	None	Serum samples
Blue top	Sodium citrate	Coagulation studies
Green top	Sodium heparin	Plasma samples
Lavender top	EDTA	Complete blood count

Disconnecting Syringe and Applying Pressure

7. Disconnect the syringe from the PICC line:

a. Ensure the tourniquet is still in place.

b. Grasp the syringe hub with one hand and the needle with the other hand.

c. Gently twist the syringe back and forth while holding the needle steady.

d. Once the needle is loose, pull the syringe straight out from the catheter.

8. Apply pressure to the puncture site:

a. With the needle removed, place a gauze pad over the puncture site.

b. Apply firm and steady pressure for 2-3 minutes, or until the bleeding stops.

c. If the bleeding persists, apply a second gauze pad and continue applying pressure.

9. Dispose of the used syringe and gauze pad properly:

a. Place the syringe and gauze pad in a sharps container or biohazard waste bag.

b. Dispose of the container or bag according to the facility’s policy.

Step	Action
7a	Ensure tourniquet is in place.
7b	Grasp syringe hub and needle.
7c	Twist syringe and hold needle steady.
7d	Pull syringe straight from catheter.
8a	Place gauze over puncture site.
8b	Apply firm pressure for 2-3 minutes.
8c	Add gauze and continue pressure if bleeding persists.
9a	Dispose of syringe and gauze in sharps container.
9b	Dispose of container according to policy.

Dressing and Bandaging the Insertion Site

8. Dressing and Bandaging the Insertion Site

Once the PICC line is inserted, the insertion site must be dressed and bandaged to protect it from infection and to prevent the line from being dislodged. The dressing and bandage should be changed every 2 to 3 days, or more often if it becomes soiled or wet. Dressing changes should be performed by a healthcare professional.

Materials needed:

Material	Quantity
Sterile gauze pads	4-6
Sterile tape	1 roll
Antiseptic solution	1 bottle
Normal saline	1 bottle

Steps:

Gather the materials.
Wash your hands thoroughly with soap and water.
Clean the insertion site with antiseptic solution.
Apply sterile gauze pads to the insertion site.
Secure the gauze pads with sterile tape.
Label the dressing with the date and time.
Monitor the insertion site for signs of infection.
Change the dressing every 2 to 3 days, or more often if it becomes soiled or wet.

Documenting and Labeling the Blood Samples

Accurate documentation and proper labeling of blood samples are crucial to ensure patient safety and the integrity of test results. Follow these guidelines to ensure proper documentation and labeling:

1. **Collect the Correct Information:** Obtain the patient’s full name, medical record number, date of birth, and the date and time of blood draw.

2. **Use the Correct Labels:** Use pre-printed labels or fill out labels clearly with the patient’s name, medical record number, and date of birth.

3. **Label Each Tube Individually:** Each tube containing a blood sample should be labeled with the patient’s information.

4. **Use Appropriate Additives:** If the blood draw requires specific additives (e.g., anticoagulant), ensure the correct type and amount of additive is added to the tube.

5. **Seal the Tubes Tightly:** All tubes containing blood samples should be sealed tightly to prevent leakage or contamination.

6. **Place Samples in a Collection Container:** Place the labeled tubes in an appropriate collection container.

7. **Record the Blood Draw in the Patient’s Chart:** Document the date, time, and type of blood draw in the patient’s medical record.

8. **Submit Samples to the Laboratory:** Submit the labeled samples to the laboratory promptly according to established protocols.

9. **Additional Considerations for PICC Line Blood Draws:**

a. **Flush the PICC Line:** Before drawing blood, flush the PICC line with 5-10 mL of normal saline.

b. **Discard the First 5 mL of Blood:** The first 5 mL of blood drawn may contain fluid from the PICC line, so discard it to avoid contamination.

c. **Collect Blood in a Vacuum Tube:** Use a vacuum tube to collect blood from the PICC line to ensure adequate flow and prevent hemolysis.

d. **Label Vacuum Tubes Clearly:** Clearly label the vacuum tubes with the patient’s name, medical record number, date and time of blood draw, and the type of blood draw.

Troubleshooting Common Issues

If you encounter difficulties while drawing blood from a PICC line, follow these troubleshooting tips:

**1. No Blood Return:**

Ensure the PICC line is properly flushed with saline.
Check if the tourniquet is placed correctly and not too tight.
Try using a different needle size or brand.

**2. Slow Blood Return:**

Increase the flushing rate or consider using a heparin lock flush.
Apply a warm compress to the insertion site.
Avoid bending or kinking the PICC line during blood draw.

**3. Clot Formation:**

Aspirate slowly and gently.
Consider using a clotting time analyzer to ensure the patient’s blood is not clotting prematurely.
Flush the PICC line more frequently with saline.

**4. Hemolysis:**

Use a smaller needle size and a slower aspiration rate.
Avoid shaking or agitating the blood sample.
Centrifuge the blood sample gently.

**5. Air Embolism:**

Check if the PICC line is properly primed.
Elevate the patient’s arm to promote air evacuation.
Contact a physician immediately if an air embolism is suspected.

**6. Infection:**

Inspect the insertion site for redness, swelling, or drainage.
Change the dressing regularly and follow proper infection control measures.
Contact a physician if signs of infection are present.

Issue	Troubleshooting Tips
No Blood Return	Flush PICC line, check tourniquet, try different needle
Slow Blood Return	Increase flushing rate, apply warm compress, avoid bending PICC line
Clot Formation	Aspirate slowly, use clotting time analyzer, flush PICC line more frequently
Hemolysis	Use smaller needle, slower aspiration rate, avoid shaking sample
Air Embolism	Prime PICC line properly, elevate patient’s arm, contact physician
Infection	Inspect insertion site, change dressing, contact physician

How to Draw Blood From a PICC Line

A PICC line is a peripherally inserted central catheter that is placed in a large vein in the arm. It is used to draw blood for testing, administer medications, and provide fluids. To draw blood from a PICC line, you will need the following supplies:

Alcohol swabs
Gauze padsSyringe
Tourniquet
Butterfly needle
Blood collection tube

Once you have gathered your supplies, follow these steps to draw blood from a PICC line:

1. Wash your hands and put on gloves.
2. Apply a tourniquet to the arm about 4 inches above the PICC line insertion site.
3. Clean the PICC line insertion site with an alcohol swab.
4. Insert the butterfly needle into the PICC line.
5. Attach the syringe to the butterfly needle and draw the blood into the syringe.
6. Remove the syringe from the butterfly needle and attach the blood collection tube to the syringe.
7. Invert the blood collection tube and gently mix the blood with the anticoagulant.
8. Remove the tourniquet and apply pressure to the insertion site with a gauze pad.