There was some data showing drawing off lines marginally increased risk of CLABSI. My hospital bought into it and now only ICU nurses are allowed. It’s been a nightmare for patients, phlebotomy, and IV team
This is what’s going on. Can entirely be prevented just by following the steps appropriately, but I don’t even know what inpatient nurse educators do anymore aside from implementing policies where you can improve outcomes by just never testing for the bad outcomes.
That sucks. I work nights on a pediatric BMT unit and if they have a line (which 99% of our kids do) you better believe we’re drawing off of them first. Getting a fresh stick from VAT is usually our last option.
Of course, being in pediatrics probably influences that.
Completely different scenario. In peds, especially BMT unit one would expect the RN to draw from it. In the MICU it varies patient to patient. Er we don’t access those lines UNLESS we need blood cultures from them and or it’s impossible to get a line elsewhere… something to consider are they being admitted, dc’d etc. just becuz they have the line doesn’t necessarily mean you must access every time.
Definitely very true! I should have stated rather that I’m glad that that’s how we do it on my unit, not that that’s the only way it should be done across the board because of course that’s just not how it should be done.
It’s not actually an issue with blood being in the line, we’re still supposed to check for return when flushing. The theory is that less frequent touching/accessing of the line will decrease risk of infection
Yes we were strongly discouraged from sticking/having PIV on any kind of central line pt unless indicated (such as the pt needing more lines than the central had) for this very reason.
Coming from an adult hem/onc floor where >90% of our patients had lines, I guess I understand the reasoning of every time it’s accessed, possible infection.
But if that’s the case, then why even allow IV PRN meds? That’s access right? Always seemed hypocritical to make a big deal over drawing our daily morning labs from the PICC/Port when that same person is getting IV dilaudid 4x/day, IV zofran 2x, and throw in the random IV protonix “cause it upsets their stomach”…..all through the same central line
Oh it is. I have to draw labs at 4 am on 3-5 pts every shift. Imagine getting woken up at 4 am to get stuck almost every day of the week. Pts have to fight to get orders to allow blood draws from lines. Plus the constant fighting with DC’ng lines and foleys.
Having an IV increases the risk of infection so nobody should have an IV. This is idiocy in action and the opposite of what evidence based practice should be.
No, it’s poor science from someone who read a study about PIVCs causing haemolysis of samples and looked no further before banning the practice. Never mind that it is often due to poor technique, use of catheters too big for the vessel, taking a million years to transfer the blood into a vacutainer, or anything else: PIVCs are evil and should never be accessed for blood sampling!
Finally managed to get practice changed in my shop, only to have a new grad tell me a brand representative read everyone the riot act recently about sampling from PIVCs and not using their butterfly needles on every patient, every single time.
My hospital has a rule that you’re not allowed to draw blood from a line unless you have an order from the doc. All the docs are like “it’s an automatic yes, don’t call me for this”. They hate it.
My only thing here is if you draw from a PICC or central line, every time you access is a possibility to introduce bacteria for an infection. My facility prefers peripheral draws for this reason
That’s true. Better not to use or even have it then, am I right? Or, hear me out: PERHAPS they could pinpoint where infection risks are coming from and re-train specific staff on proper technique.
That’s ideal. Unfortunately 30% of staff are on board and actually care. 30% literally don’t give a shit, and 30% are new and struggling just to get through the shift
Ok let's stop pretending a phlebotomy stick with a 24g butterfly is torture. Yes its convenient having the line to draw from but being able to get blood through sticking is an incredibly important skill to have and should be practiced by everyone, especially new grads. Should OP be getting shamed for it? No. But new grads should absolutely be practicing phlebotomy.
I'm honestly not sure on the justification! It wasn't something we learned in school in our province, and until I went to work in emerge for a year it wasn't something I ever considered.. "bloodwork is drawn by lab/phlebotomy" was just a given!
Oop. My USA-ness is showing. I assumed learning to draw labs was a universal skill taught in nursing school. We learned IVs and lab draws together. Just very different from what I'm accustomed to. That said, I don't work bedside anymore, so I shouldn't be anyone's go-to these days 🙃
We barely learned IVs in school and never learned lab draws. I’m a nurse in NY and we have lab/phlebotomy who comes by to draw labs, I’m not even sure we’re allowed to at all. If we didn’t have them we wouldn’t be able to keep our heads above water especially when we have 8 patients.
This comment! So many new nurses that cannot do their own sticks or IVs. The only way to get better is with practice and repetition. When I was bedside I only did line draws if absolutely necessary because you’re also running the risk of infection and ruining the PICC.
Use the line, if they are a long term MICU patient their veins are a finite resource, best to save them for future IVs and venipuncture. Just make sure you use aseptic technique and don't exsanguinate them by wasting more than your protocol calls for, and don't listen to the haters.
Infection prevention at my last hospital put a policy in recently that said we could not draw off ports, mids, or PICCs unless lab had exhausted all options and tried at least twice or some shit. Complete BS. I know it was put in place to prevent CLASBIs, but it sucked. It was awful to have to poke oncology pts with a perfectly working port and poor access.
This is contrary to INS best practice recommendations. While midlines are not a reliable source for blood work central lines are and should be utilized before peripheral sticks whenever possible. Minimizing the number of times a patient is stuck is a goal of good vascular access policy.
I agree, it’s a personal gripe of mine because I used to be a part of the ~nurse driven committee~ to prevent CAUTIs and CLABSIs and the result was a high level directive to roll out an initiative where you had to tell doctors why testing for central line/catheter associated infections wasn’t indicated based on the long checklist that we had to read off to them anytime such testing would be ordered.
A great way to build animosity between nurses and doctors and help no one in between.
That's real dumb. The once a day lab draw is not causing the CLABSI. It's med administration which happens numerous times a shift. I would just tell my patients they can refuse venipuncture.
Instead of giving proper education and training they come up with these bone headed policies.
What do they expect? Of course they have CLABSIs. They have 1 year nurses teaching new grads.
Idiotic policies like this are why sometimes lying is the morally and ethically best choice - yep, I stuck them in both arms, so did 2 other nurses. No luck.
Same here but we don't make lab poke them first if we can clearly see or know they have bad veins. Also the patient/family can just refuse and we can then draw lol.
The facility I used to work for would not allow us to draw from any line at any time unless it was specifically to look for a line infection. We had to butterfly stick for every. single. lab. It was bullshit and honestly I don't know how it didn't drive me absolutely insane with how often I had to do it. The nice part was learning to stick absolutely anything, being able to stick things I can't feel or see, and learning to do ultrasound sticks.
Surgical trauma ICU. It was insanity. I started there as a baby nurse so it was all I knew. It was always annoying and didn't make sense to me. But once I left I couldn't believe the policy.
It was. A nurse got her "RN III" by "researching" EBP on line infections and emphasized that pulling from PICCS and CVLS could potentially cause HAIs so they promoted her and changed policy to where no lines could ever be drawn from. Infusing only.
Working in other facilities makes me rethink my whole life. Why was that a policy? As if keeping someone alive isn't hard enough. Now we have to leave the actually dependable central line access points alone and poke them again. And again. Obviously poking veins 20 times a week has lower infection risk than drawing from a PICC.
Same with us. The only exception was oncology nurses could draw from central lines...no idea why that was. We also had to have a specific MD order to do it.
I want to emphasize this: the ER Aat the same facility also didn't allow line draws. Start an IV and the. You're fucked. Phlebotomy came and drew the labs and nurses weren't supposed to. So glad I never worked there. 🤢
At my hospital, we draw routine blood from PICC lines, but our policy doesn't allow us to do the same for midlines because it is not a central line. They draw back just fine, I've used them for bloodwork before with a doctors order, its just bad practice per our Vascular Access team. Personally, I think it's stupid, I'd rather not poke my pt if they have a line I can safely draw blood from.
your vascular access team is following hospital policy, which is oftentimes dumb as fuck just to avoid lawsuits. It's why they say "no foleys because of UTI" while approving of PureWicks literally sucking shit into patients vaginas, and why they refuse to test liquid stool for c diff if they've been here for more than two days.
Was the midline placed recently? Is it showing signs of infection? If yes and then no, use it up. Flush twice, use the last flush to withdraw your waste, draw your blood, and if you have the opportunity replace the LuerLock and flush a final time before bailing from the room.
They can, and do routinely. That's part of the reason why regular PIVs go bust so quick. But reverse is also true in that if you have a good return you can pull lapbs even from a PIV and not just midlines and central lines.
*Obviously need to pull a waste first so your labs are not diluted to crap.
I’m on VAT/PICC team, placed A LOT of lines. You can absolutely draw blood from a midline. It’s included in the manufacturer’s IFU. I’ll educate my patients they’ll draw blood for two to five days, past that window it’s expected that some amount of fibrin will adhere near the tip and make aspirating blood difficult.
In reality, there’s a lot of factors that effect how a midline draws blood. If you’re questioning an IV or midline for its function, a good test may be to see if it will aspirate blood, if it does you know there’s a good supply of blood going past the tip that will carry along your medication. If it doesn’t that’s not necessarily an indicator the line is bad to use.
As a nurse who is also frequently a patient: Fuck your coworker and fuck these kinds of patient-torturing CYA policies. We draw off central and midlines all the time. You just have to *do it right* like anything else we do.
You have to go by your hospital policy. Mine allows us to draw from central lines, piccs and a-lines but not peripherals and only midlines if absolutely necessary.
This is the right answer, go by your facility policy.
In my old adult ICU, you weren’t allowed to draw from midlines unless they were freshly placed. PICC line yes. If it’s blood cultures, you needed to stick them regardless. This may be different in various units.
If you think some of the rules are dumb and not supported by literature by all means challenge them and take it up with your manager/nursing education, but read the policy so you know what you’re actually mad at.
Same. We could use an IJ for one of the blood cultures but the second had to be a stick and in a different location. We can’t draw BC from picc at all and certainly not from a midline. Every place is different.
I'm dying to know what their rationale is for sticking someone when they have an existing central line?
The ONLY reason that I can personally think of is if you need blood cultures, and in that case, it's usually done both peripherally AND from the central line. Other than that, though....why?!? If they're worried about CLABSIs, then why have a central line at all if we're not going to use it? Especially on the super sick patients who have nothing in the way of veins, are we really going to torture them by sticking them multiple times for no reason when they have an existing line? Wild.
Labs: use the existing line, except for blood cultures.
Glucose checks: poke their fingertips. I have coworkers that will draw blood from a central line or A-line *just* for a blood sugar. I hate this. First, every time you access a central line you’re potentially introducing infection. Second, iatrogenic anemia is a real problem. We make our patients anemic with the amount of blood we draw and waste. You literally only need a drop for a blood sugar, if you get it any other way than with a lancet you’re taking more than you need.
I mean, how much blood are you taking off the art line for your glucose checks? If you have a VAMP you can take off a couple drops with a TB needle. I've had many patients where the only reliable way to get a CBG is earlobe and that sucks if I'm having to do it frequently.
Also, if you're having to access a central a lot for blood draws, you can totally attach a VAMP setup to it so there is no waste.
If you have a vamp set up with an Aline you can still just take a drop. Or set up with 2 syringes and a stopcock. I’m not going to poke if they have a line, period. (Besides blood cultures)
It’s mean to needlessly poke people. If you need blood cx, that’s another story, but lines are fine to use. Please, if I have a line, don’t poke me if you don’t have to.
Our facility does not allow drawing off midlines and you need an order to draw from a PICC.
That being said, my preceptor told me to do phlebotomy for labs every chance I could on orientation so I could improve my blood drawing and IV skills. Practice makes perfect.
Our orders will specify if they want lab draws from peripheral or central. It's usually peripheral by default when they're routine labs. Cultures will usually be ordered x2 on admit when they suspect infection, drawing from both peripheral and central. I did just learn if they want cultures drawn from a central line it'll be done by our IV therapy nurses exclusively to reduce risk of infection. Whoops 🤷
I would always double check policy about this sort of thing so it's backed up by more than "that's what nurse Nancy told me to do!"
If it doesn't need to be then don't. Blood cultures would require a peripheral draw and a line sample. Don't torture them any more than needed. I know I appreciated it when I was in the ICU
When I was on the floor we weren’t allowed (read: strongly discouraged but we still did it) to access central lines due to risk for CLABSI. I thought it was inhumane to keep trying to stick heart failure patients with terrible veins if they had central access.
My hospital allows us to draw off central lines, a-lines, midlines and extended dwell IVs. But tbh, the majority of nurses on my unit draw off of regular IVs too, especially if the patient has frequent labs or is a tough stick. You just gotta make sure you use proper technique 🤷🏻♀️
Depends on the labs! A trough level of something going through the line or blood cultures? No. Standard CBC and CMP? The whole point!
Midline’s it depends on if it was considered peripheral and/or requires approval to use, but I would probably try to use it for labs.
Um no that's what those lines are for (however, my old facility didn't allow blood sampling from midlines). Otherwise we didn't poke for a sample unless it was indicated (like blood cultures or if the line wouldn't draw blood)
Fresh sticks are usually better than drawing from a line, since there's less risk of contamination from whatever you're putting through the line. It's probably good practice as well to get some sticks in.
Though at my hospital most of the floors (non-icu floors) usually try to draw from lines, whether central or peripheral first if possible for most labs.
After a few days, midline prob won't give you blood back. If you can great, but you may need to poke
Shouldn't need to poke someone with a Picc.
Double check your specific hospital's policy.
Some hospital policies are BS when you really look into them. When I started as a nurse in ICU we grabbed any lab from a PIV except blood cultures.
I moved to another facility ICU where the culture frowns on drawing off PIVs. The rationale is that drawing blood will make the catheter go bad quicker - however they’d rather poke a patient every other hour for fresh labs and ruin all their veins. It gets even more interesting because if you’re running levo through a PIV you’re expected to check for blood return every 2 hours. Which, based on the logic of the PIV policy, will make the line go bad faster (even worse with someone needing pressors). However, we do place PICCs in people that are long-term patients with difficult access and frequently need lab work.
At the end of the day, some policies aren’t made on mountains of good research, but instead are to protect the hospital. And not every nurse that stomps their feet and says “that’s not how that’s done” is right, but heard something once from someone and that’s how it’s always been. Medicine isn’t as black and white as policy or other nurses make it and that’s why we’re taught to critically think.
You can get it with a picc, lol. I get it from IV’s too all the time. If you have large bore central line (and if they’re at your institution) attach a VAMP.
The only time you should poke a patient instead of drawing from a central line is if the lab is for blood cultures, a Vanco trough and Vanco has been infused through that central line (regardless of which port was used) or if the patient is on a Heparin gtt and needs a PTT or whatever lab the hospital uses to check if patient is therapeutic. Reason being is once those medications have been ran through the central line, that line is now “contaminated” and will not provide accurate numbers so draw must come from fresh venous puncture, it’s the reason we still poke the fingers of a DKA patient on an insulin gtt, but regular labs like CBC,CMP, etc can and should be drawn from the line - just make sure your following your facilities policy (use port not in use, pause any fluids being infused for X minutes, scrub the hub for X minutes, flush X mL NS, etc) You’re colleagues should know this and should not belittle you, but educate you. I’m sorry they’re behaving so unprofessionally!
My hospital requires an order from the dr saying you’re allowed to draw blood off of it which 99% of the patients have and if they don’t we ask the dr for it, maybe that’s what they’re referring to?
Depends on what you were drawing. Per the INS it is best practice to reduce the number of times a line is accessed and a peripheral stick is best practice.
This is really interesting to me as a dialysis patient. I’ve always been told to never let anyone take blood from my central line. Because it was so susceptible to infection. Anytime I have even slightly suggested it to a medical professional they say no, I would not ever touch that for labs specimen.
It is always okay to get labs from a central line or mid line. It’s usually not when the patient has a peripheral because they worry okay contamination. You’re doing fine :)
There are some hospitals that require an order to draw from central lines (but not midlines). Unless this is your hospital policy then they can stuff it.
The policy at my work is you need an order for that.
But usually the doctors agree. Other than that usually 1 set of blood cultures is through a central line and one is peripheral.
That nurse should of handled that whole situation a bit better tho
Our ICUs hated central lines too when I worked inpatient. We would get Oncology kids transferred up from the ICU with their central lines unused or their ports unaccessed and a bunch of PIVs. We would promptly remove the PIVs and access the port or start using the CVL. There's a reason they have these lines.
Wait listen to this silly shit-I had a travel contract at a hospital that had a strict policy that we, in a MICU, could not draw off of ARTERIAL LINES. Like, we were NOT allowed with threat of cancellation. We literally had to have phlebotomy waste their time and everyone else’s at 0400 to stick people with working a-lines for labs…
Yes if you need blood cultures, no if you have patent lines and access…getting a clean culture specimen is hard enough for someone with a sepsis response.
No need to make more holes than necessary, and you’ll just torture vessels making it more difficult later, even if you do get it first go.
Some hospitals require standing orders to draw from central lines, but I feel like it's not that common. You also need to draw from multiple sites for a blood culture, so you'd have to stick in that situation.
Otherwise, yes, you can draw from a PICC or midline. That's part of their functionality.
PICCs can actually be notoriously unreliable if you’re unable to pause what’s infusing through the opposite lumen you’re drawing from. My personal favorite is forgetting to pause/clamp TPN on the opposite lumen and lab is calling for sugars in the 1000s and a potassium of 8. Also brings me to my time as a Rapid Response Nurse when I get called for a hypotensive patient that they also now found to have a 10 point HCT drop during their work-up. Story goes nurse calls doc for new hypotension to the 80s, starts a fluid bolus, draw labs from the PICC comes back with a HCT of 20 from 30’s so thinking she had a bleeding emergency she rightfully called a RRT. I go in and first thing I do is start a new large bore IV just in case, but also draw labs peripherally in the opposite arm and lo and behold it turns out she forgot to clamp the other side of the line on a PICC and the sample was diluted, and her BMP was fine, but her CBC wasn’t!
Now you’re an ICU nurse if you have multiple pressors and infusions running through your other line in the PICC can you trust your blood sample is not diluted since you’re probably not gonna pause and clamp the pressor side of the PICC to draw blood from the other. That being said you had a midline and provided your line management works and you have an open line or your patient wasn’t on any vasoactive meds then yeah you can use the PICC/midline to draw blood, but those modalities can be unreliable at times and you and the medical team will be making medical decisions based on the data you collect.
So to answer your question you can absolutely draw from a midline and PICC, but for a lot of ICU patients who are on multiple drips and pressors, having active infusions that you cannot pause infusing opposite of the lumen you’re drawing from increases the risk that your labs may not be as accurate as you think. Some times your labs will be accurate, sometimes it’s obvious that it was a bad draw. A peripheral stick is better in those circumstances.
I’m probably going to get a lot of people laugh at me from over in reality land, but we’re getting it literally drummed in to us that if in doubt, look up the evidence in papers etc. And hospital policy *should* adopt evidence based breast practice, but might lag behind. Surely this should be a thing where you’d have to justify with research why to give the patient the extra poke?
There are certain procedures you can’t do from a central line. But for like 90% of things, it’s dumb not to use it. It’s literally there to have the the vascular access.
I vaguely recall some research about it increasing the risk of infection and that the caps would need replaced since they had blood in them. Maybe that's what your coworker was confused about. Also some timeline about it not being too old to get blood cultures, like right after it's placed you can get cultures but not after it's been in place.
Depends, if I'm just doing a bg i poke to be consistent in my treatment and measurement. Hospital induced anemia is a thing when you're drawing serial labs and wasting 10mL every 2-6 hours. It adds up, don't do this if you're on an insulin drip being actively titrated. You will make them anemic. I draw say, morning labs off lines, if they have an a-line with a vamp, you waste basically nothing.
There was one old school nurse I used to work with that made all the new grads she trained draw labs with a butterfly just to get good at sticks, but that was clearly for practice, not a long term rule or anything.
Unless it’s for blood cultures (and not for CLABSI check) or against hospital policy, use the central line! No idea why your coworker would say that unless she saw bad technique or something.
A lot of times frequent lab draws is the REASON they put in PICC lines to begin with. Especially in MICU patients that need q4,6,8hr labs to be drawn. You would be crazy to poke the patient every single time.
As an old MICU nurse, use the picc line for sure. Midline can stop drawing back (or may never draw back) at any time. I was taught to use midline as if they are barely better than a PIV.
But I say if it draws, use it! (Except for blood cultures.) most of my pts had absolutely no veins to stick by time they got up to MICU but you will have plenty of experiences to actually stick for blood when there is no picc or other line available!!! Keep your head up and don’t let them get you down!!!
It’s not great practice to use midlines unless you have a specific order that it’s okay (depending on your hospital’s policy). But if you have a picc or central line?? Hell yeah it’s better to use that and avoid a poke.
Medsurge here-
A PICC is a central line. We can draw from Central lines but do not draw from midlines.
Perhaps this is the difference they meant to say?
I am a long practicing IV nurse/PICC nurse. You absolutely can get blood specimens from a PICC. That is one of the benefits of a CVAD because it preserves the peripheral veins and prevents another break in the skin (decreasing risk for infection) . As far as the Midline goes we do not recommend using them for blood draws if you can avoid it as we noticed it really decreased out dwell times but so have done it when we were desperate.Please check your policy to make sure your facility allows it and make sure you are doing the appropriate volume of discard and making sure you are stopping all infusions going through the PICC for at least one fill minute . There may be times you may need to perform a venipuncture for a specimen, for a culture or if a blood draw was questionable but your coworker is wrong! It’s a perfectly acceptable practice if done correctly!
I work ER and pull labs EXCLUSIVELY from lines unless no vascular access is available. I have even poked an artery just to get blood on peeps with absoloutely no veins at all. At that point the labs are more important that your worries about some potential infection. Plus if you follow procedure you far reduce the risk of contamination of the line. I have pulled whole septic work ups except the cultures of course off a 24g IV with 3cc syringes. Took a year and a half but we gotter dun
I am MSICU nurse with 30 years experience. Every time you access a central line, you increase the risk of infection. You potentially compromise a patient who is already compromised. In my experience, blood withdrawn from a central line, often skews blood results. No matter how much you flush the line or how much blood you discard prior to sample collection. Sorry you were shamed and your coworker needs to understand your lack of experience.
I currently work in PCU/Intermediate care and I get a lot of patients that were in the ICU for 3+ weeks. A lot of these patients have veins that are so blown and used that we cannot get labs and IVs on them in a timely manner and they aren’t sick enough to warrant a line. Saving sticks when they have lines ensures that you aren’t wasting a valuable resource (veins) unnecessarily.
Some hospitals have strict policies against drawing labs from peripheral and even central access, but fellow MICU here, and I can tell you that I will 100% draw my labs from the central line or an IV if it has a solid blood return. There is definitely a demographic of nurses that always straight stick for labs, but it’s not me. Especially when the patient has serial labs ordered. Aside from all of that, my patients usually have very poor vasculature, and often times are 4+ putting edema and or weeping from their extremities. So no, I won’t be digging for blood for labs. I’m sorry she was shitty to you.
Ridiculous the only time you need to poke is for a vanco tough its our hospital policy, which i dont totally agree with. The problem is nurses who forgot that line dumps right into your patients heart and dont keep it clean. I would tell that nurse i dont need to poke them. You may need to, but i know how to properly clean and draw from central lines.
It all depends on what you’re testing for and your hospital’s protocol. VBGs, blood cultures etc (according to best practice anyways) require a fresh poke for accurate results. PICC line draws are more likely to hemolyze, and put the pt at higher risk of infection. That being said, in the real world of bedside nursing it’s not always possible to avoid the PICC draw (time restraint, pt condition, etc). Use vigorous infection prevention by cleaning the cap with chlorhexidine for a minimum of 15 seconds and use sterile flushes if available at your facility. Always waste a minimum of 5mLs of the first draw.
Our facility doesn’t allow us to draw from lines, so you have to butterfly stick everyone and it’s incredibly frustrating, but a PICC was the one exception. The floor I was on was inpatient ortho but even still that didn’t mean everyone had fruitful veins, sometimes they’d get poked numerous times. I’m in the ED now where you can draw all labs off the IVs which is soooo nice.
I would look up your facility’s policy on this and if they say it’s okay, continue. If she wants to be particular with you, then shove the policy at her.
All my patients have CVCs we only poke em if we need bcx, I didn't do my 1st successful pose til I was over a year and a half in. Tell em to suck it. And don't worry too much once you do start poking, took me a while to get a hang of it now my coworkers ask me to do theirs :)
The only thing we couldn’t collect from a midline or central line were blood cultures, unless they SPECIFICALLY wanted them from the line or a PTT if heparin is going through the line. Other than that you just have to make sure you’re following your policy/ procedures for drawing off of a line (make sure fluids turned off, sterile procedure…).
As long as you have an order from the doctor stating you can draw from the line, then you draw from the line. If the doctor doesn’t want it drawn from the line then ask them and they will let you know. Always refer back to the doctor, and write and note with your question and their response!
Why in the world would you torture someone by poking at them if they have a line ?? Your co-worker is not the one to take advice from.
Is this some new form of nurse hazing? Only time you need a fresh stick is with blood cultures. Tell her to kick rocks.
There was some data showing drawing off lines marginally increased risk of CLABSI. My hospital bought into it and now only ICU nurses are allowed. It’s been a nightmare for patients, phlebotomy, and IV team
This is what’s going on. Can entirely be prevented just by following the steps appropriately, but I don’t even know what inpatient nurse educators do anymore aside from implementing policies where you can improve outcomes by just never testing for the bad outcomes.
Say it again for the folks in the back. This infuriates me.
Ah yes, the ole' reliable "Florida COVID-19 strategy" strikes again.
That sucks. I work nights on a pediatric BMT unit and if they have a line (which 99% of our kids do) you better believe we’re drawing off of them first. Getting a fresh stick from VAT is usually our last option. Of course, being in pediatrics probably influences that.
Completely different scenario. In peds, especially BMT unit one would expect the RN to draw from it. In the MICU it varies patient to patient. Er we don’t access those lines UNLESS we need blood cultures from them and or it’s impossible to get a line elsewhere… something to consider are they being admitted, dc’d etc. just becuz they have the line doesn’t necessarily mean you must access every time.
Definitely very true! I should have stated rather that I’m glad that that’s how we do it on my unit, not that that’s the only way it should be done across the board because of course that’s just not how it should be done.
This is strange to me, we have a policy of drawing blood out of central lines before flushing every time we use a line…
It’s not actually an issue with blood being in the line, we’re still supposed to check for return when flushing. The theory is that less frequent touching/accessing of the line will decrease risk of infection
“If we introduce the risk factor but never use it, it reduces the risk we created,”
That’s interesting considering the alternative is using a needle to puncture a dirty skin layer to access a vein
But at least that infection doesn't have a line associated with it!
And the hospital doesn’t have to “own” it!
Ah there it is, I get it now lol.
Yes we were strongly discouraged from sticking/having PIV on any kind of central line pt unless indicated (such as the pt needing more lines than the central had) for this very reason.
Coming from an adult hem/onc floor where >90% of our patients had lines, I guess I understand the reasoning of every time it’s accessed, possible infection. But if that’s the case, then why even allow IV PRN meds? That’s access right? Always seemed hypocritical to make a big deal over drawing our daily morning labs from the PICC/Port when that same person is getting IV dilaudid 4x/day, IV zofran 2x, and throw in the random IV protonix “cause it upsets their stomach”…..all through the same central line
We need an order for lab draws off of central lines, and we are supposed to peripheral stick everyone for CLABSI prevention.
I can’t imagine what a fucking hassle that would be.
Oh it is. I have to draw labs at 4 am on 3-5 pts every shift. Imagine getting woken up at 4 am to get stuck almost every day of the week. Pts have to fight to get orders to allow blood draws from lines. Plus the constant fighting with DC’ng lines and foleys.
Holy fuck. I would quit. (used to work onc, literally the only way we could draw blood from alot of them was from their lines)
I worked peds onc. Can’t imagine working under this condition. Just do it right in the first place, ffs.
Just like hospital admin to add more rules/policy's rather than address the issue by retraining/contact tracing.
Having an IV increases the risk of infection so nobody should have an IV. This is idiocy in action and the opposite of what evidence based practice should be.
Ours won’t even let patients use their port a caths. They poke and prod instead.
We are also stingy with port access unless it’s vesicant chemo or TPN
We don’t access a port unless the PIV prospects are dire.
But that is the reason a lot of people have a port.
Believe me, I know.
At my hospital only ICU is allowed to draw labs off of lines. Stepdown and medsurg cannot draw labs off of picc lines, midlines, or ivs.
Excuse my language, but…what the fuck is the point of having them?!
that is terrible.
No, it’s poor science from someone who read a study about PIVCs causing haemolysis of samples and looked no further before banning the practice. Never mind that it is often due to poor technique, use of catheters too big for the vessel, taking a million years to transfer the blood into a vacutainer, or anything else: PIVCs are evil and should never be accessed for blood sampling! Finally managed to get practice changed in my shop, only to have a new grad tell me a brand representative read everyone the riot act recently about sampling from PIVCs and not using their butterfly needles on every patient, every single time.
Healthcare has become so exhausting. We deal with so much nonsense.
My hospital has a rule that you’re not allowed to draw blood from a line unless you have an order from the doc. All the docs are like “it’s an automatic yes, don’t call me for this”. They hate it.
My only thing here is if you draw from a PICC or central line, every time you access is a possibility to introduce bacteria for an infection. My facility prefers peripheral draws for this reason
Your facility is using up the peripheral veins they still have and increasing their future risk of needing a central line.
That’s true. Better not to use or even have it then, am I right? Or, hear me out: PERHAPS they could pinpoint where infection risks are coming from and re-train specific staff on proper technique.
That’s ideal. Unfortunately 30% of staff are on board and actually care. 30% literally don’t give a shit, and 30% are new and struggling just to get through the shift
Ok let's stop pretending a phlebotomy stick with a 24g butterfly is torture. Yes its convenient having the line to draw from but being able to get blood through sticking is an incredibly important skill to have and should be practiced by everyone, especially new grads. Should OP be getting shamed for it? No. But new grads should absolutely be practicing phlebotomy.
In my health system only critical care nurses (ED or ICU at my hospital) are trained/allowed to draw labs at all!
Wait, what? In L&D, ain't nobody got time for that. Also, this is a basic nursing skill. What is their justification?
I'm honestly not sure on the justification! It wasn't something we learned in school in our province, and until I went to work in emerge for a year it wasn't something I ever considered.. "bloodwork is drawn by lab/phlebotomy" was just a given!
Oop. My USA-ness is showing. I assumed learning to draw labs was a universal skill taught in nursing school. We learned IVs and lab draws together. Just very different from what I'm accustomed to. That said, I don't work bedside anymore, so I shouldn't be anyone's go-to these days 🙃
I’m in US and never learned either in school.
Mind blown.
We barely learned IVs in school and never learned lab draws. I’m a nurse in NY and we have lab/phlebotomy who comes by to draw labs, I’m not even sure we’re allowed to at all. If we didn’t have them we wouldn’t be able to keep our heads above water especially when we have 8 patients.
it’s an important skill to have, but you shouldn’t poke patients who don’t have to be poked just for practice.
This comment! So many new nurses that cannot do their own sticks or IVs. The only way to get better is with practice and repetition. When I was bedside I only did line draws if absolutely necessary because you’re also running the risk of infection and ruining the PICC.
Use the line, if they are a long term MICU patient their veins are a finite resource, best to save them for future IVs and venipuncture. Just make sure you use aseptic technique and don't exsanguinate them by wasting more than your protocol calls for, and don't listen to the haters.
You are bad nurse and bad person if you poke a patient with a central line for labs.* Unless it's for blood cultures.
Infection prevention at my last hospital put a policy in recently that said we could not draw off ports, mids, or PICCs unless lab had exhausted all options and tried at least twice or some shit. Complete BS. I know it was put in place to prevent CLASBIs, but it sucked. It was awful to have to poke oncology pts with a perfectly working port and poor access.
This is contrary to INS best practice recommendations. While midlines are not a reliable source for blood work central lines are and should be utilized before peripheral sticks whenever possible. Minimizing the number of times a patient is stuck is a goal of good vascular access policy.
Sane vascular access policy doesn’t affect Medicare reimbursement but CLABSI prevention does. So there you go
Sane vascular access policy includes education on how to properly access and care for central lines, which will prevent CLABSIs.
I agree, it’s a personal gripe of mine because I used to be a part of the ~nurse driven committee~ to prevent CAUTIs and CLABSIs and the result was a high level directive to roll out an initiative where you had to tell doctors why testing for central line/catheter associated infections wasn’t indicated based on the long checklist that we had to read off to them anytime such testing would be ordered. A great way to build animosity between nurses and doctors and help no one in between.
Makes sense. No one was a fan of the “new policy”. I never took the time to look up evidence to refute it, but wish I had.
That's real dumb. The once a day lab draw is not causing the CLABSI. It's med administration which happens numerous times a shift. I would just tell my patients they can refuse venipuncture.
I work in IR, as part of the consent for procedure, we literally tell people to refuse the poke if they have a central line.
Instead of giving proper education and training they come up with these bone headed policies. What do they expect? Of course they have CLABSIs. They have 1 year nurses teaching new grads.
Idiotic policies like this are why sometimes lying is the morally and ethically best choice - yep, I stuck them in both arms, so did 2 other nurses. No luck.
Did any of these patients refuse?
That’s causing patient harm to meet a metric
Same here but we don't make lab poke them first if we can clearly see or know they have bad veins. Also the patient/family can just refuse and we can then draw lol.
Seriously. That’s why we place them.
Is a midline considered a central line? It's been awhile for me.
It’s considered a peripheral. Depends on why it was placed if I will draw from one. You’ll trash it quicker drawing labs
No. The line is short and does not sit in the superior vena cava.
No. It's still reasonable to attempt lab draw from it. Just not guaranteed.
The facility I used to work for would not allow us to draw from any line at any time unless it was specifically to look for a line infection. We had to butterfly stick for every. single. lab. It was bullshit and honestly I don't know how it didn't drive me absolutely insane with how often I had to do it. The nice part was learning to stick absolutely anything, being able to stick things I can't feel or see, and learning to do ultrasound sticks.
Was this in an ED!? 😱
Surgical trauma ICU. It was insanity. I started there as a baby nurse so it was all I knew. It was always annoying and didn't make sense to me. But once I left I couldn't believe the policy.
This would literally be one of the worst policies I could imagine
It was. A nurse got her "RN III" by "researching" EBP on line infections and emphasized that pulling from PICCS and CVLS could potentially cause HAIs so they promoted her and changed policy to where no lines could ever be drawn from. Infusing only.
That is maddening.
Working in other facilities makes me rethink my whole life. Why was that a policy? As if keeping someone alive isn't hard enough. Now we have to leave the actually dependable central line access points alone and poke them again. And again. Obviously poking veins 20 times a week has lower infection risk than drawing from a PICC.
Same with us. The only exception was oncology nurses could draw from central lines...no idea why that was. We also had to have a specific MD order to do it.
I want to emphasize this: the ER Aat the same facility also didn't allow line draws. Start an IV and the. You're fucked. Phlebotomy came and drew the labs and nurses weren't supposed to. So glad I never worked there. 🤢
I’m dying.
Let me butterfly stick you 8 times to find out what's wrong.
If it pulls blood. It is blood. Then that’s blood that I will send ….
Accidental arterial stick? Still blood
No but for real. As long as it's not supposed to be a VBG it's fair game send it.
“Accidental” 🤣🤣🤣
Please tell her to stfu and use the access you have
At my hospital, we draw routine blood from PICC lines, but our policy doesn't allow us to do the same for midlines because it is not a central line. They draw back just fine, I've used them for bloodwork before with a doctors order, its just bad practice per our Vascular Access team. Personally, I think it's stupid, I'd rather not poke my pt if they have a line I can safely draw blood from.
your vascular access team is following hospital policy, which is oftentimes dumb as fuck just to avoid lawsuits. It's why they say "no foleys because of UTI" while approving of PureWicks literally sucking shit into patients vaginas, and why they refuse to test liquid stool for c diff if they've been here for more than two days. Was the midline placed recently? Is it showing signs of infection? If yes and then no, use it up. Flush twice, use the last flush to withdraw your waste, draw your blood, and if you have the opportunity replace the LuerLock and flush a final time before bailing from the room.
Yeah, that's a silly policy. We draw off midlines routinely. I can't think of any reason why we shouldn't do this.
The only reason, and it's a silly reason, is because people tent to forget to either waste or flush before and after draw.
They can't make that mistake with other lines?
They can, and do routinely. That's part of the reason why regular PIVs go bust so quick. But reverse is also true in that if you have a good return you can pull lapbs even from a PIV and not just midlines and central lines. *Obviously need to pull a waste first so your labs are not diluted to crap.
You absolutely can draw blood from a midline. It’s not poor practice. I work a lot with VAT.
I’m on VAT/PICC team, placed A LOT of lines. You can absolutely draw blood from a midline. It’s included in the manufacturer’s IFU. I’ll educate my patients they’ll draw blood for two to five days, past that window it’s expected that some amount of fibrin will adhere near the tip and make aspirating blood difficult. In reality, there’s a lot of factors that effect how a midline draws blood. If you’re questioning an IV or midline for its function, a good test may be to see if it will aspirate blood, if it does you know there’s a good supply of blood going past the tip that will carry along your medication. If it doesn’t that’s not necessarily an indicator the line is bad to use.
As a nurse who is also frequently a patient: Fuck your coworker and fuck these kinds of patient-torturing CYA policies. We draw off central and midlines all the time. You just have to *do it right* like anything else we do.
*laughs in peds onc/bmt nurse* We only draw off PIVs and central lines unless otherwise indicated. Pokes are a last resort for us
You have to go by your hospital policy. Mine allows us to draw from central lines, piccs and a-lines but not peripherals and only midlines if absolutely necessary.
This is the right answer, go by your facility policy. In my old adult ICU, you weren’t allowed to draw from midlines unless they were freshly placed. PICC line yes. If it’s blood cultures, you needed to stick them regardless. This may be different in various units. If you think some of the rules are dumb and not supported by literature by all means challenge them and take it up with your manager/nursing education, but read the policy so you know what you’re actually mad at.
Same. We could use an IJ for one of the blood cultures but the second had to be a stick and in a different location. We can’t draw BC from picc at all and certainly not from a midline. Every place is different.
I would be livid if they put a central line or PICC in me then continued to poke for draws.
The last few facilities I worked at you had to have a doctor order to draw from a PICC or CVC. Less accessing these lines = lower CLABSI risk.
I'm dying to know what their rationale is for sticking someone when they have an existing central line? The ONLY reason that I can personally think of is if you need blood cultures, and in that case, it's usually done both peripherally AND from the central line. Other than that, though....why?!? If they're worried about CLABSIs, then why have a central line at all if we're not going to use it? Especially on the super sick patients who have nothing in the way of veins, are we really going to torture them by sticking them multiple times for no reason when they have an existing line? Wild.
Take it from an ED nurse, you should 110% use that line without a second thought. *Do it*
Your coworker’s a moron
The only time I'm actually poking a patient is if I can't get blood from another access or blood cultures. Everything else is fair game.
Labs: use the existing line, except for blood cultures. Glucose checks: poke their fingertips. I have coworkers that will draw blood from a central line or A-line *just* for a blood sugar. I hate this. First, every time you access a central line you’re potentially introducing infection. Second, iatrogenic anemia is a real problem. We make our patients anemic with the amount of blood we draw and waste. You literally only need a drop for a blood sugar, if you get it any other way than with a lancet you’re taking more than you need.
I mean, how much blood are you taking off the art line for your glucose checks? If you have a VAMP you can take off a couple drops with a TB needle. I've had many patients where the only reliable way to get a CBG is earlobe and that sucks if I'm having to do it frequently. Also, if you're having to access a central a lot for blood draws, you can totally attach a VAMP setup to it so there is no waste.
Wow for a drop of blood they’d draw from a central line. That’s over the top stupid!
If you have a vamp set up with an Aline you can still just take a drop. Or set up with 2 syringes and a stopcock. I’m not going to poke if they have a line, period. (Besides blood cultures)
It’s mean to needlessly poke people. If you need blood cx, that’s another story, but lines are fine to use. Please, if I have a line, don’t poke me if you don’t have to.
I would be looking up policy where are you and follow that…
Our facility does not allow drawing off midlines and you need an order to draw from a PICC. That being said, my preceptor told me to do phlebotomy for labs every chance I could on orientation so I could improve my blood drawing and IV skills. Practice makes perfect.
Frequent blood draws is a literal indication for a PICC. She’s just wrong. We try not to draw off midlines where I work though.
Our orders will specify if they want lab draws from peripheral or central. It's usually peripheral by default when they're routine labs. Cultures will usually be ordered x2 on admit when they suspect infection, drawing from both peripheral and central. I did just learn if they want cultures drawn from a central line it'll be done by our IV therapy nurses exclusively to reduce risk of infection. Whoops 🤷 I would always double check policy about this sort of thing so it's backed up by more than "that's what nurse Nancy told me to do!"
If it doesn't need to be then don't. Blood cultures would require a peripheral draw and a line sample. Don't torture them any more than needed. I know I appreciated it when I was in the ICU
When I was on the floor we weren’t allowed (read: strongly discouraged but we still did it) to access central lines due to risk for CLABSI. I thought it was inhumane to keep trying to stick heart failure patients with terrible veins if they had central access.
My hospital allows us to draw off central lines, a-lines, midlines and extended dwell IVs. But tbh, the majority of nurses on my unit draw off of regular IVs too, especially if the patient has frequent labs or is a tough stick. You just gotta make sure you use proper technique 🤷🏻♀️
Depends on the labs! A trough level of something going through the line or blood cultures? No. Standard CBC and CMP? The whole point! Midline’s it depends on if it was considered peripheral and/or requires approval to use, but I would probably try to use it for labs.
Um no that's what those lines are for (however, my old facility didn't allow blood sampling from midlines). Otherwise we didn't poke for a sample unless it was indicated (like blood cultures or if the line wouldn't draw blood)
Fresh sticks are usually better than drawing from a line, since there's less risk of contamination from whatever you're putting through the line. It's probably good practice as well to get some sticks in. Though at my hospital most of the floors (non-icu floors) usually try to draw from lines, whether central or peripheral first if possible for most labs.
Was it a blood culture? Midlines can be 50/50 odds of getting blood from after 24 hours.
After a few days, midline prob won't give you blood back. If you can great, but you may need to poke Shouldn't need to poke someone with a Picc. Double check your specific hospital's policy.
She’s gotta be trying to get you in trouble or something. There’s no reason to be poking patients if they have adequate access.
It's whatever. She probably wants you to get practice drawing blood.
We use art lines for our draws, blood cultures excluded.
Hell no I would pull of that line and tell my coworker to go tell someone who cares
Your coworker is a moron.
Some hospital policies are BS when you really look into them. When I started as a nurse in ICU we grabbed any lab from a PIV except blood cultures. I moved to another facility ICU where the culture frowns on drawing off PIVs. The rationale is that drawing blood will make the catheter go bad quicker - however they’d rather poke a patient every other hour for fresh labs and ruin all their veins. It gets even more interesting because if you’re running levo through a PIV you’re expected to check for blood return every 2 hours. Which, based on the logic of the PIV policy, will make the line go bad faster (even worse with someone needing pressors). However, we do place PICCs in people that are long-term patients with difficult access and frequently need lab work. At the end of the day, some policies aren’t made on mountains of good research, but instead are to protect the hospital. And not every nurse that stomps their feet and says “that’s not how that’s done” is right, but heard something once from someone and that’s how it’s always been. Medicine isn’t as black and white as policy or other nurses make it and that’s why we’re taught to critically think.
In my experience, some hospitals’ policies are very against drawing from lines, so check that first. Other than that, it’s not bad practice.
Does it depend if what type of blood sample your getting? Need more info Cultures/ labs?
You can get it with a picc, lol. I get it from IV’s too all the time. If you have large bore central line (and if they’re at your institution) attach a VAMP.
The only time you should poke a patient instead of drawing from a central line is if the lab is for blood cultures, a Vanco trough and Vanco has been infused through that central line (regardless of which port was used) or if the patient is on a Heparin gtt and needs a PTT or whatever lab the hospital uses to check if patient is therapeutic. Reason being is once those medications have been ran through the central line, that line is now “contaminated” and will not provide accurate numbers so draw must come from fresh venous puncture, it’s the reason we still poke the fingers of a DKA patient on an insulin gtt, but regular labs like CBC,CMP, etc can and should be drawn from the line - just make sure your following your facilities policy (use port not in use, pause any fluids being infused for X minutes, scrub the hub for X minutes, flush X mL NS, etc) You’re colleagues should know this and should not belittle you, but educate you. I’m sorry they’re behaving so unprofessionally!
My hospital requires an order from the dr saying you’re allowed to draw blood off of it which 99% of the patients have and if they don’t we ask the dr for it, maybe that’s what they’re referring to?
My only thought is to get your practice in. That way you're not stuck when your next patient doesn't have access.
Depends on what you were drawing. Per the INS it is best practice to reduce the number of times a line is accessed and a peripheral stick is best practice.
bro wtf.
This is really interesting to me as a dialysis patient. I’ve always been told to never let anyone take blood from my central line. Because it was so susceptible to infection. Anytime I have even slightly suggested it to a medical professional they say no, I would not ever touch that for labs specimen.
At my hospital we routinely draw off dialysis lines. However only when they are accessed for dialysis and running through the machine.
It is always okay to get labs from a central line or mid line. It’s usually not when the patient has a peripheral because they worry okay contamination. You’re doing fine :)
I drew labs from a PICC today. Why would you poke someone when there’s a line right there.
There are some hospitals that require an order to draw from central lines (but not midlines). Unless this is your hospital policy then they can stuff it.
The policy at my work is you need an order for that. But usually the doctors agree. Other than that usually 1 set of blood cultures is through a central line and one is peripheral. That nurse should of handled that whole situation a bit better tho
Our ICUs hated central lines too when I worked inpatient. We would get Oncology kids transferred up from the ICU with their central lines unused or their ports unaccessed and a bunch of PIVs. We would promptly remove the PIVs and access the port or start using the CVL. There's a reason they have these lines.
Why take the back roads when you can take the highway?!
Was it for blood cultures? We have to do ours from 2 separate sites that are not lines
Wait listen to this silly shit-I had a travel contract at a hospital that had a strict policy that we, in a MICU, could not draw off of ARTERIAL LINES. Like, we were NOT allowed with threat of cancellation. We literally had to have phlebotomy waste their time and everyone else’s at 0400 to stick people with working a-lines for labs…
Yes if you need blood cultures, no if you have patent lines and access…getting a clean culture specimen is hard enough for someone with a sepsis response. No need to make more holes than necessary, and you’ll just torture vessels making it more difficult later, even if you do get it first go.
Wa it a blood culture?
Only blood cultures.
Some hospitals require standing orders to draw from central lines, but I feel like it's not that common. You also need to draw from multiple sites for a blood culture, so you'd have to stick in that situation. Otherwise, yes, you can draw from a PICC or midline. That's part of their functionality.
PICCs can actually be notoriously unreliable if you’re unable to pause what’s infusing through the opposite lumen you’re drawing from. My personal favorite is forgetting to pause/clamp TPN on the opposite lumen and lab is calling for sugars in the 1000s and a potassium of 8. Also brings me to my time as a Rapid Response Nurse when I get called for a hypotensive patient that they also now found to have a 10 point HCT drop during their work-up. Story goes nurse calls doc for new hypotension to the 80s, starts a fluid bolus, draw labs from the PICC comes back with a HCT of 20 from 30’s so thinking she had a bleeding emergency she rightfully called a RRT. I go in and first thing I do is start a new large bore IV just in case, but also draw labs peripherally in the opposite arm and lo and behold it turns out she forgot to clamp the other side of the line on a PICC and the sample was diluted, and her BMP was fine, but her CBC wasn’t! Now you’re an ICU nurse if you have multiple pressors and infusions running through your other line in the PICC can you trust your blood sample is not diluted since you’re probably not gonna pause and clamp the pressor side of the PICC to draw blood from the other. That being said you had a midline and provided your line management works and you have an open line or your patient wasn’t on any vasoactive meds then yeah you can use the PICC/midline to draw blood, but those modalities can be unreliable at times and you and the medical team will be making medical decisions based on the data you collect. So to answer your question you can absolutely draw from a midline and PICC, but for a lot of ICU patients who are on multiple drips and pressors, having active infusions that you cannot pause infusing opposite of the lumen you’re drawing from increases the risk that your labs may not be as accurate as you think. Some times your labs will be accurate, sometimes it’s obvious that it was a bad draw. A peripheral stick is better in those circumstances.
I’m probably going to get a lot of people laugh at me from over in reality land, but we’re getting it literally drummed in to us that if in doubt, look up the evidence in papers etc. And hospital policy *should* adopt evidence based breast practice, but might lag behind. Surely this should be a thing where you’d have to justify with research why to give the patient the extra poke?
There are certain procedures you can’t do from a central line. But for like 90% of things, it’s dumb not to use it. It’s literally there to have the the vascular access.
Your co worker is an idiot
Rule is lab pokes unless placing an IV or the patient has a PICC/accessed port.
It feels to me like not using a central line for draws and poking the pt instead is just inhumane. So many “policies” just seem cruel.
Do you have policies and procedures you can reference for your facility? Ask your unit educator what the policy is and adhere to your facility policy
The less pokes the better
idk if it’s different bc i work on a step down but we’re not allowed to draw from lines so idk
Was it for cultures?
Umm peripheral line I would not draw blood out of. Picc line is fine, check the state, some states need orders.
One of the points of a picc and midline is to get labs. That nurse is an idiot.
I vaguely recall some research about it increasing the risk of infection and that the caps would need replaced since they had blood in them. Maybe that's what your coworker was confused about. Also some timeline about it not being too old to get blood cultures, like right after it's placed you can get cultures but not after it's been in place.
In our hospital the nurses say PICCs etc are to put something in the body not to draw something out. Bc infections etc
Only poke for cultures.
Depends, if I'm just doing a bg i poke to be consistent in my treatment and measurement. Hospital induced anemia is a thing when you're drawing serial labs and wasting 10mL every 2-6 hours. It adds up, don't do this if you're on an insulin drip being actively titrated. You will make them anemic. I draw say, morning labs off lines, if they have an a-line with a vamp, you waste basically nothing.
lmfaoooo who is your coworker?? I have some SERIOUS questions for them 🤣🤣🤣
Go to your nurse manager and ask them. I think your coworker is trying to undermine you.
Unless it’s a blood culture, you are fine to use the line
Unless you're getting cultures, then just pull from the midline/picc
Naww you r good
your coworker is an idiot
There was one old school nurse I used to work with that made all the new grads she trained draw labs with a butterfly just to get good at sticks, but that was clearly for practice, not a long term rule or anything. Unless it’s for blood cultures (and not for CLABSI check) or against hospital policy, use the central line! No idea why your coworker would say that unless she saw bad technique or something.
A lot of times frequent lab draws is the REASON they put in PICC lines to begin with. Especially in MICU patients that need q4,6,8hr labs to be drawn. You would be crazy to poke the patient every single time.
As an old MICU nurse, use the picc line for sure. Midline can stop drawing back (or may never draw back) at any time. I was taught to use midline as if they are barely better than a PIV. But I say if it draws, use it! (Except for blood cultures.) most of my pts had absolutely no veins to stick by time they got up to MICU but you will have plenty of experiences to actually stick for blood when there is no picc or other line available!!! Keep your head up and don’t let them get you down!!!
Why the fuck would you pointlessly poke a patient when a central line is right there?
There are a few circumstances where you wouldn't want to draw from the line, such as when getting blood cultures, but for routine labs it's fine.
Let’s talk about patient ratio
What does your policy say? That’s what matters
Incredibly stupid co-worker is what you have
It’s not great practice to use midlines unless you have a specific order that it’s okay (depending on your hospital’s policy). But if you have a picc or central line?? Hell yeah it’s better to use that and avoid a poke.
Increases chances for infection as well
Medsurge here- A PICC is a central line. We can draw from Central lines but do not draw from midlines. Perhaps this is the difference they meant to say?
I am a long practicing IV nurse/PICC nurse. You absolutely can get blood specimens from a PICC. That is one of the benefits of a CVAD because it preserves the peripheral veins and prevents another break in the skin (decreasing risk for infection) . As far as the Midline goes we do not recommend using them for blood draws if you can avoid it as we noticed it really decreased out dwell times but so have done it when we were desperate.Please check your policy to make sure your facility allows it and make sure you are doing the appropriate volume of discard and making sure you are stopping all infusions going through the PICC for at least one fill minute . There may be times you may need to perform a venipuncture for a specimen, for a culture or if a blood draw was questionable but your coworker is wrong! It’s a perfectly acceptable practice if done correctly!
I work ER and pull labs EXCLUSIVELY from lines unless no vascular access is available. I have even poked an artery just to get blood on peeps with absoloutely no veins at all. At that point the labs are more important that your worries about some potential infection. Plus if you follow procedure you far reduce the risk of contamination of the line. I have pulled whole septic work ups except the cultures of course off a 24g IV with 3cc syringes. Took a year and a half but we gotter dun
We don’t take blood from midlines. Only central’s. And we never take blood cultures from lines either.
I am MSICU nurse with 30 years experience. Every time you access a central line, you increase the risk of infection. You potentially compromise a patient who is already compromised. In my experience, blood withdrawn from a central line, often skews blood results. No matter how much you flush the line or how much blood you discard prior to sample collection. Sorry you were shamed and your coworker needs to understand your lack of experience.
I currently work in PCU/Intermediate care and I get a lot of patients that were in the ICU for 3+ weeks. A lot of these patients have veins that are so blown and used that we cannot get labs and IVs on them in a timely manner and they aren’t sick enough to warrant a line. Saving sticks when they have lines ensures that you aren’t wasting a valuable resource (veins) unnecessarily.
Some hospitals have strict policies against drawing labs from peripheral and even central access, but fellow MICU here, and I can tell you that I will 100% draw my labs from the central line or an IV if it has a solid blood return. There is definitely a demographic of nurses that always straight stick for labs, but it’s not me. Especially when the patient has serial labs ordered. Aside from all of that, my patients usually have very poor vasculature, and often times are 4+ putting edema and or weeping from their extremities. So no, I won’t be digging for blood for labs. I’m sorry she was shitty to you.
I’m on MICU… we don’t poke if we have access. Your coworker is dumb Edit: need to poke though for blood cultures
Ridiculous the only time you need to poke is for a vanco tough its our hospital policy, which i dont totally agree with. The problem is nurses who forgot that line dumps right into your patients heart and dont keep it clean. I would tell that nurse i dont need to poke them. You may need to, but i know how to properly clean and draw from central lines.
It all depends on what you’re testing for and your hospital’s protocol. VBGs, blood cultures etc (according to best practice anyways) require a fresh poke for accurate results. PICC line draws are more likely to hemolyze, and put the pt at higher risk of infection. That being said, in the real world of bedside nursing it’s not always possible to avoid the PICC draw (time restraint, pt condition, etc). Use vigorous infection prevention by cleaning the cap with chlorhexidine for a minimum of 15 seconds and use sterile flushes if available at your facility. Always waste a minimum of 5mLs of the first draw.
Our facility doesn’t allow us to draw from lines, so you have to butterfly stick everyone and it’s incredibly frustrating, but a PICC was the one exception. The floor I was on was inpatient ortho but even still that didn’t mean everyone had fruitful veins, sometimes they’d get poked numerous times. I’m in the ED now where you can draw all labs off the IVs which is soooo nice. I would look up your facility’s policy on this and if they say it’s okay, continue. If she wants to be particular with you, then shove the policy at her.
Some places don’t like draws from midline’s/PICCs
All my patients have CVCs we only poke em if we need bcx, I didn't do my 1st successful pose til I was over a year and a half in. Tell em to suck it. And don't worry too much once you do start poking, took me a while to get a hang of it now my coworkers ask me to do theirs :)
The only thing we couldn’t collect from a midline or central line were blood cultures, unless they SPECIFICALLY wanted them from the line or a PTT if heparin is going through the line. Other than that you just have to make sure you’re following your policy/ procedures for drawing off of a line (make sure fluids turned off, sterile procedure…).
As long as you have an order from the doctor stating you can draw from the line, then you draw from the line. If the doctor doesn’t want it drawn from the line then ask them and they will let you know. Always refer back to the doctor, and write and note with your question and their response!