RE: PICC with TPN and lab samples

[Lynn Hadaway]

Title: RE: PICC with TPN and lab samples

I will offer my first thought as a possible scenario and maybe an engineer can add to this discussion. When drawing a blood sample with a large 10 ml syringe, you are exerting greater pressure on the catheter. This is the opposite of injection where a larger syringe is indicated to reduce the pressure exerted on the catheter.

The power-injectable PICCs have larger lumens than other PICCs. There could be some communication between the lumens through the septum between the lumens but I think this would be rare. If this is happening, it would be a much greater problem for everyone and would probably occur in the same lot numbers. Is it possible that a 10 mL syringe is exerting so much pressure that fluid from the lumen used for high glucose or electrolyte infusion (e.g., TPN) is being pulled out of that lumen, through the lumen used for sampling and into the syringe?

Does this occur equally when a vacuum tube system is used or with a smaller syringe? Just a few wild thoughts on the issue. Lynn

At 7:36 AM -0500 8/16/06, Feckers, Charlotte wrote:

We have had this problem as well especially with our Power Picc's.  They also seem to be getting higher then normal potassium levels when drawn off the power picc's. I know they have used different techniques when drawing to try to eliminate the problem in ICU.  I would love to hear what others are seeing and what they use for a technique if any different.

Charlotte

 

Charlotte Feckers RN CRNI
ICU
Covenant Medical Center
C[EMAIL PROTECTED]

 

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From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway
Sent: Tuesday, August 15, 2006 2:00 PM
To: G.G. Northington; [EMAIL PROTECTED]
Subject: Re: PICC with TPN and lab samples

Hyperglycemia is a warning sign of infection. The methods of testing for glucose is different in the lab vs the point-of-care testing with the finger stick. So there is reason to be concerned.

There is also concern about the technique of drawing the sample if the nurses do not routinely turn off the infusion of all fluids through all lumens when drawing a blood sample. This should be standard practice to increase the chances of getting a true lab value.

Is there no way to draw a regular blood sample from a peripheral stick on this patient? If not, I would definitely make sure they turn off all infusions for one full minute before drawing the sample from the PICC. Also you have D5 infusing through the lumen where you are taking the sample. What are the flushing practices before drawing the sample? Lynn

At 10:26 AM -0500 8/15/06, G.G. Northington wrote:

I have a patient that had a  dual lumen power PICC inserted on 8-3-06.  TPN was initiated through one lumen and the other lumen utilized for maintaince fluids (D51/2 NS) and lab draws.  The last 3-4 days (not consecutive) the patient's glucose has been elevated on the lab results, but a finger stick has had much lower results.  The patient's WBC's are elevated, but not a new finding.  The physician is concerned with infection.  My first thought was that the nurses are pulling the TPN with their lab draw.--It is common practice on this floor to draw the lab work while the TPN is infusing, so I suggested to stop it briefly before the next lab draw to see if there is a difference in the results. 

With the background given, what are your thoughts on possible infection vs. the nurses "technique" on obtaining the sample?

Thanks, G.G.

 

G.G. Northington,RN,BSN

PICC Nurse

Jackson Hospital & Clinic,Inc. 

Montgomery,AL  36016

334-293-6858

[EMAIL PROTECTED]

 

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Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861

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Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861