Peak and Trough

[TonyaH]

Hi there,
It has been my experience that any time Andrew is on ivs that require peak and trough levels, those levels cannot be drawn through his picc. The reason given to me is that using the line through which the medication was infused can skew lab results if remaining medication were to be left in the line when levels were drawn. Makes perfect sense to me. Andrew is just used to having levels drawn peripherally once his picc has been used to administer meds.

This time around we are using a different home health company and saw our nurse for the first time. She was very sweet, but insisted it is okay to draw his levels through his picc, and that is typical of this particular company. Well, I like change about as much as I like mosquitos flying around my face while I'm trying to sleep. You are talking to a girl who cried for a week when the TV show Friends ended. I"m flipping out a little over this change in routine.

Obviously I'm going to call UNC tomorrow and make sure they are good with this, but I really don't think they are going to be because they have specifically requested peripheral draws from home health before. But this has me wondering...is this a UNC thing, or a national thing? What does your hospital request from home health when running drug levels while on ivs?

 

[cygrant04]

My daughter always gets peak and through though her port. They just flush it first. I figure she goes through to much already. I only take her to UNC once a year (because its about 4 hours away) and they told us it was fine.

 

[jessconn]

Our CF center is at a children's hospital and they have always wanted drug levels from peripheral or finger stick, not through her port or a picc line. Our home health nurse said that most kid hospitals want it that way for more accurate levels. She said the adult hospital usually doesn't care. I do think it is better not to do it from the site that the antibiotic goes in because it can skew the results.

 

[Jane]

Our clinic always wants levels drawn from a blood draw not from a PICC. The nursing company insists on drawing off the PICC so we usually ask the dr to write a note so they don't end up having to repeat tests.

 

[bloggymom]

From what I was told it depends on the drug. I am on amikacin and they can take my peak and trough right from my PICC line. Sweet deal. No pokes or prodding. I did Tobra a few years ago and they HAD to do sticks. I was told that Tobra stays in the line and corrupts the blood draw.

 

[semperfiohana]

That's a no no. It can skew the results. Pretty sure UNC will say the same thing. Pretty sure that when I was going to UNC it was always a poke blood draw and not from the picc.

 

[littlemisscoughsalot]

Tobra is stciky stuff. Even if you flush really well, it can stay in the line and give elevated results. Usually with kids, they will undershoot the dose a bit, and then do the draw to make sure the med is within a theraputic range. If it is drawn from a line that has had the med run through it, the result could show more elevated than it actually is in the body, indicating that the dose is correct.

As we all know, improper use of antibiotics is the main cause of resistance. Plus you want the round of IVs to do the trick and kill those bugs!!

 

[TonyaH]

Thanks everyone,
It sounds like UNC's way is in line with other hospitals. I'm going to insist on the peripheral sticks moving forwards...Should have trusted my instinct last night.

 

[MichaelL]

My experience is the same as most above -- peak and trough should not be drawn from the PICC line. I was on Amikacin and they would not use the PICC line for those tests.

For me, drawing blood through my PICC line had led to it blocking. As a result, they never draw blood from my line anymore.

 

[triples15]

It seems maybe I'm the minority here, but I've always had double-lumen PICCs. The one line is used for meds (including Tobra) and the other is used for lab draws, including peak and trough. We are sure to never infuse meds thru the "blood" line. That always worked well for me with no probs w/clotting etc.

With my port (that I just lost), they said trough levels were safe to draw thru the port, but peak had to be a poke. We also used my port for routine lab draws. I'd like to say there is no problem with this practice but my port just had to be removed after the catheter tore and almost broke completely off from the actual port itself. No one can say why, but it was 3 years old with very light use (ie. one round of IVs and monthly flushes).

Sorry, kind of off a tangent. I think you are prob right to insist on the poke, even tho they are no fun! That is, unless it happens to be a double-lumen. Then you'd be ok if Tobra wasn't infused thru the one line.

Take care and keep up the good work!

Autumn 32 w/Cf