Blood sampling discard volume from PICC
Abstract:
Background: Vascular access devices (VADs) are increasingly used for blood sampling, yet optimal discard volumes remain uncertain, particularly when EDTA-based lock solutions are used.
Objective: To evaluate whether discarding 1 mL is sufficient for reliable laboratory testing after use of 4% tetrasodium EDTA catheter lock solution (Kitelock™) in PICC.
Methods: In a prospective study, 10 patients with single-lumen peripherally inserted central catheters (polyurethane, 4F, open-ended) underwent blood sampling after flushing the catheter and discarding 1 mL, corresponding to approximately two dead spaces for the shortened catheters used. Five consecutive tubes were analyzed per sample type (biochemistry, hematology, coagulation). Agreement with the reference tube (tube 5) was assessed using Bland-Altman plots, clinically acceptable intervals (CAI), intraclass correlation coefficient (ICC), and Lin’s concordance correlation coefficient (CCC).
Results: In the first tube, several analytes reached 10/10 comparisons within the CAI (urea, sodium, potassium, calcium, magnesium, alkaline phosphatase, erythrocytes, hematocrit, MCV, leucocytes, thrombin time). Others showed 9/10 comparisons (total protein, albumin, chloride, hemoglobin, thrombocytes, APTT, prothrombin time, fibrinogen). Only creatinine reached 8/10.
Conclusions: Discarding 1 mL appeared sufficient for reliable testing after Kitelock™ use in our cohort, but confirmation in larger studies is warranted.
Reference:
Rajdl D, Maxová KK, Chovancová J, Vodičková P, Bultasová L, Fejt M, Prokop P, Koldušková K, Kletečka J. Influence of an EDTA-based catheter lock solution on blood discard volume in PICC. J Vasc Access. 2025 Dec 14:11297298251403726. doi: 10.1177/11297298251403726. Epub ahead of print. PMID: 41392469.