Blood Draw from PICC Line Explained

What is a PICC Line?

PICC or Peripherally Inserted Central Catheter is used for intravenous access in the medium to long-term. It is a silicone or polyurethane long hollow tube that is inserted into a peripheral vein in the arm or in the upper arm using an ultrasound guide.

It is threaded along the vein until the tip rests in the superior vena cava where maximum blood flow allows administered drugs or fluids to be diluted immediately.

Intravenous administration of drugs or fluids is the primary use of the PICC line. But it can also be used to draw blood for lab work and for other purposes.

Unlike other procedures for collecting blood samples, PICC blood draw has a set of steps that must be followed.

The CDC specified that PICC blood draw procedure should be as follows:

1. Maintain aseptic technique when accessing the catheter as outlined.
2. Remove the first 3 to 5 ml of blood and then discard.
3. Obtain blood specimen.
4. Flush the PICC line with a 10 to 20-ml normal saline. If necessary, clamp the catheter when flushing is complete.
5. Dispose the used syringe promptly.
6. When procedure is complete, perform hand hygiene.

Other sources that outline blood draw from PICC line provide a similar process but more extensive and specific.

Aseptic Nontouch Technique (ANTT)

PICC line blood draw policy requires blood sampling from a PICC line to use ANTT, a standardized aseptic technique that identifies and protects key parts to prevent introduction of infection and other PICC line blood draw problems.

Key elements are:

• To institute a non-touch technique to protect key parts and key sites
• Perform effective hand hygiene using liquid soap and water or alcohol based hand rub before and after each episode of direct contact or care.
• Follow essential infection control measures to prevent introduction of pathogenic microorganisms found on equipment, surfaces, and hands to susceptible sites during a PICC blood draw.

Hand Hygiene

The 2014 National based guidelines for preventing healthcare-associated infections not only specified what to use for hand decontamination but also when to use it.

Alcohol-based hand rub should only be used in the following situations:

• When there is no contact with body fluids that are potentially contaminated
• When hands are not visibly soiled
• When not caring a patient with diarrhea or is vomiting

PICC Line Blood Draw Supplies

• Alcohol pads
• Sterile chlorhexidine 2% in alcohol 70% solution or swab
• Clean plastic tray or dressing pack
• Non-sterile gloves (powder free)
• 10ml syringe or size appropriate for lab studies
• Prefilled and labeled 10cc normal saline syringes
• Luer adaptor
• Vacutainer blood transfer device
• Vacutainer blood collection tubes
• Heplock 5cc syringe (if applicable)
• Trash receptacle/Sharps bin
• Lab Requisition with specimen labels

PICC line blood draw with vacutainer uses a vacutainer system with PICC lines to collect samples.

PICC Blood Draw Procedure

Note: When drawing blood from a picc line it is always important to keep in mind the order of draw. Depending on the labs you will be drawing from the patient.

1. Choose a port to draw blood.
2. Clean port for 15 seconds with an alcohol swab.
3. Lock the pre-filled normal saline syringe to the port using a luer adaptor. Unclamp the catheter tubing.
4. Using push/pause flushing method, slowly flush saline into the catheter.
5. Draw the appropriate amount of blood. Clamp catheter afterward.
6. Remove syringe and then discard in a biohazard container.
7. Attach a syringe filled with 10 ml normal saline, release clamp, and flush the catheter. Re-clamp catheter when done.
8. Lock line with a Heplock solution if there is no infusion. Otherwise, reconnect infusion.
9. Attach the vacutainer transfer device to the syringe and insert tubes in order of draw.
10. At patient’s bedside, label tubes and place in transport bag along with lab requisition.
11. In the EMR, document procedure and patient tolerance.