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anybody use a picc line?
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anybody use a picc line?

My veins are so hard to hit and most of them have been blown and are useless.  I got my starting bloodwork drawn today and the nurse recommended I get a picc line for blood draws during tx.  I only have one good vein other than my feet and if they blow it I'm in trouble.  Has anybody had a picc line for tx or know if it's a good option?
16 Comments Post a Comment
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3867523_tn?1348953285
It sounds like a good idea, but I've worked as a nurse anesthetist for most of the last thirty years and pic lines are very good for putting medications into, unfortunately they are not so good for getting blood out of.  The medication going in is under some amount of pressure and causes the line to dilate somewhat.  When you're trying to draw blood out, the opposite is true and the tubing tends to contract under negative pressure and it doesn't work so well.  I haven't read any studies but my experience is as I have described.  Garry
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Avatar_m_tn
i spent three weeks in an ICU, not as a result of treatment, and had a subclavian line for drugs, blood components and nutrition. seems to me like it would be difficult to maintain a picc line for the duration of treatment.  perhaps you could discuss finger stick draws with the nurse, doc and lab. unfortunately finger stick cbcs are not as accurate as venous draws. also you might find out who the best phlebotomist where you have your blood drawn and and try to make appointments with him or her. warming the skin prior to the drawn can make it easier to hit the vein.
eric
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446474_tn?1404424777
Are these phlebotomists that do blood draws all day long? I have no problem with them but regular nurses I have had many problems over the years. Lots of digging and missing and my blood flow stopping after one tube.

Suggestions:

* Drink lots of fluids the day before and day of the blood draw.

* Apply heat (compress, pad) to the arm and blood draw site for 10-20 minutes before the draw. Dress more warmly than you would ordinarily do for the weather that day, to keep your body surface and skin temperature elevated a bit. You can always shed the extra layer or two once your stick is over.

* Ask the phlebotomist to try an alternate site, such as the back of your hand.

It is interesting what Garry says about the PICC line being used for infusion rather than drawing blood. Thanks Garry for your expertise.

Good question.

Cheers!
Hector
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2061362_tn?1353283118
Just adding to Hector's suggestion, how bout a butterfly blood draw? I have only one good vein that blood will come out of for some reason, and if I was poked too much and sore, the lab person would use one.
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766573_tn?1365170066
I probably should gloss through your posts to see if you have some underlying medication condition that contributes to this so admittedly without having done that I agree with Hector an Garry.

Most nurses I have come across can draw blood quite efficiently however a nurse is not a phlebotomist (and vice versa). It sounds like the PICC line is more for the convenience of the nurse.

Consider what Garry says in his post. A PICC line is for easy venous access. But notice the key words and the circumstances it is most frequently used (intravenous therapies). The are disimiar to a once (maybe twice) weekly blood draw.:

**Prolonged** IV antibiotic treatment;

-IV access obtainable by less invasive and **longer lasting methods;

**Multiple accesses obtainable with one access line;

http://picclinenursing.com/picc_why.html

I know there are lots of people who it is not easy to find a vein. I bet a lot of people on here were like that in the beginning. I bet we are having more blood draws than some people ever have throughout their lives. Sometimes up to three tubes at a time.  Having your blood drawn is a big part of your treatment that ideally you want to be fast, easy and hassle free.

I would ask for alternatives before you consent. Perhaps they contract with a phlebotomist or if there is a local lab near by. Maybe you could go to the last place where there may not have been a struggle to obtain venous access and draw blood.

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2030686_tn?1351692148
I ask for a heat pack when I sign in and put it on my hand.  The one good vein I have is is my hand and they have to go in my feet at times.  They have to use a butterfly because the reg ones are bigger than my veins most days.  Often they will even use the black (pediatric) butterfly.  I tell them when I sign in that I'm a hard stick and am willing to wait a few extra minutes to get a more experienced tech.

The main vein that runs down the top of my hand is the only good one I have and some days it's not even possible to get that one.  They got out a veinlite last time I had an IV and they still chose my hand.  Just to make it more fun, my veins roll like crazy and tend to push the needle out.

I was thinking a picc line would only hurt once, but using an ultrasound to get a deeper vein is gonna hurt every time.  It's looking like a picc line wouldn't be reliable for very long and I wouldn't want to have it redone.
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3867523_tn?1348953285
Hector, these are all excellent suggestions.  Drinking lots of fluids before you go in may be the best among them.  
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446474_tn?1404424777
Garry I had heard that was the case but I had never tried it. I was having problems with weekly blood draws for the trial I am in as we didn't have a phlebotomist available for the draws. So I have bought two bottles of water and drunk them an hour or so before the draw. Worked wonders.
It also help with my urine test. Killed two birds with one stone.

What I have found Garry is the biggest factor in blood draws is the expertise of the technician. I have had phlebotomist close their eyes and not even look at my arm and do it all by feel. No problem. She would get it every time. No digging, no pain. The phlebotomists at our hospital lab are great. I really have no problems there at all. Nurses or other that don't did it 8 hours a day are another story. Hit and miss really. I am getting to the point that I'd do it myself if I could.

Just my 2 cents about a PICC line for testing blood levels during treatment. Maybe I am wrong but it seems like massive over kill to me. But I am no expert.

I appreciate your experience and comments. It is nice to hear an opinion from a different perspective.

Hector
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163305_tn?1333672171
I agree with Hector. Nurses have botched my blood draws. Give me an experienced phlebotomist any day over a nurse.
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179856_tn?1333550962
When I was sick the other day they told me the same thing Hector said, that because I was dehydrated my veins were flat (something like that I was in shock so I dont exactly remember).  But they definitely said it was because I was dehyrated.

So drink drink drink maybe it will help a bit?
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2030686_tn?1351692148
I typically won't let a nurse draw my blood, I go to the hospital.  Yesterday I got my blood drawn and the phlebotemist almost had to send me to do an ultrasound stick.  That just sounds extremely painful to me.  I really have no good surface veins.  I drink ALOT of water beforehand.  When the needle is in they say it's always either trying to suck up against the wall or trying to push it out.  I've tried all the usual tricks and use most of them every time.  The phlebotomist actually recommended the pic line, and she's not the first.  The more I think about it I think a picc line for blood draws would not work well for me. I still have some veins in my foot but I'm afraid with a compromised immune system (because of tx) foot bacteria would be a big deal if it got introduced into my blood.  As my husband says, I'm just difficult like that.

My platelets were low low so they want me to retest so I'll ask the phlebotomist for more suggestions.  I'm a little worried about healing time and infections with an ultrasound getting deeper veins.   I appreciate everybody's suggestions.  I'm kinda looking for an alternative blood draw method, if there is one.  I've actually had three phlebotomists at once all poking at me with their fingers to find a vein.  
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446474_tn?1404424777
You could ask for Cipro to help prevent infection if that is an issue. I took it for months when I was on treatment back in 2008 when I had compensated cirrhosis as a preventive measure.

run it sounds you you have done all the usual good practices. I would try to talk to the head of the phlebotemists or someone who has 20-30 years of experience for ideas. You are not the only person with this problem. Obviously there are many elder and chronically ill folks that have difficult issues finding veins also. Somehow they always get the blood.

Best
Hector
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1840891_tn?1383280315
Boy, I am so sympathetic to your problem! I have one vein in one inside elbow that is really excellent, but I've had a number of surgeries with long hospital stays and every time that vein gets ruined fairly early and the rest of the stay is pure hell. On one occasion they sent in eleven different people in succession before someone finally succeeded, and I think I must have gotten more than 20 sticks that one time, and they finally did use a picc line. On several different occasions they have eventually brought in an anesthesiologist. It's really hard to persuade them to take it on, but they do seem to be the most capable of all. I was stressed throughout tx that somebody would blow out my only good vein and I insisted on pediatric butterflies whenever I could. Thankfully, the phlebotomists were all pretty good and the vein held up.

I would worry a lot about getting a picc line for this, as they are a little risky (infections and blood clots) even when in a hospital setting over a relatively short time. My sister-in-law died of a blood clot from one that she'd had to use for over a year when she had intestinal obstruction. They finally cleared the obstruction and then she died of a blood clot from the picc line. It was horrible, and I'll always think of those as risky now. Here's another thought, although I don't know how practical or safe it would be: what about having a vein portal installed like they do for dialysis patients? Those are at least intended to stay in place long-term outside of a hospital setting. I really hope some kind of decent solution can be found for you!
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2030686_tn?1351692148
I had low platelets so they made me redraw today to run the test again.  Dr said I can't start tx til they get back up.  Any suggestions?
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1840891_tn?1383280315
Oh, I'm sorry to hear that! Are you cirrhotic, or do you have any other known condition that is causing the low platelets? How low are they? Someone else will probably be along with more knowledge about this, but I wanted to try to bump your question up to make it more visible. Good luck!
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2030686_tn?1351692148
I'm a geno 2 so no biopsy yet.  My bloodwork is all good but I know that can be unreliable.  I am on amoxicillin, which I think can cause my platelets to drop.  If he keeps putting my tx I'm gonna ask for a biopsy.  I'm assuming this would be a bad idea with low platelets, though.  I should know my actual count on monday, but I think they've always been on the low side of normal.
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