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Aedi Budi Dharma

Drawing blood samples from picc line

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We practically only use our PICC lines for parenteral nutrition. The small diameter (28G) only makes it possible to infuse only. 

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When i was in troubles I did blood samples through 24G lines. Then I washed with 2 U of heparin/ml saline. Never used for any transfusion. 

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Considering hygiene you should not do it, but I do it

1. if I need a blood culture and the line may be responsible for the infection,

2. if I need blood and the PICC line is about to be withdrawn,

3. in emergencies.

The technique is to withdraw with a 1 ml syringe using a constantly changing negative pressure of 0,5 ml maximum. Stop if the blood column does not move constantly (and slowly) and immediately flush with a prepared saline syringe. It works 90% of the time.

Erythrocytes are a lot smaller (7,5µm) than the inner diameter of a PICC line (28G = 1Fr has 0,17mm = 170µm). A study has shown that you can give blood via a PICC line without hemloysis (Pediatr Crit Care Med. 2004 Jan;5(1):69-74. PMID: 14697112).  See also nice experiments in https://chartermedical.com/wp-content/uploads/2015/09/TexasChildrensPDF.pdf. There it is stated that you should not do it with platelets because of clotting.

In an emergency we gave 80 ml FFP via 28G PICC line with no problems. It needs a pump with pressure cut of set to max - you can not do it by hand.

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