1. Humphries, Linda MSN, RN, CNS-AH, CCRN
  2. Baldwin, Kathleen PhD, RN, CNS, ANP, GNP, CEN

Article Content


The clinical research study was designed to determine if the policy/procedure requiring venipuncture for coagulation studies could be revised. The goal was to show no significant difference between coagulation study results drawn via venipuncture and via PICC lines using an evidence-based protocol. The results will be used to validate a change in policy/procedure.



Hospitalized patients, particularly those with PICC lines, may require anticoagulation therapy or coagulation studies to determine changes in condition. Venipuncture, a painful procedure, often results in bruising, bleeding, and increased risk for infection. It is particularly difficult in some patients with limited venous access. Our policy/procedure requires venipuncture to obtain all coagulation test samples.



An evidence-based protocol was developed for drawing coagulation studies from PICC lines. The study compared results from coagulation studies drawn from a PICC using the evidence-based protocol and samples drawn via venipuncture.



Purposive sampling was used. All patients admitted to the hospital with PICC lines were asked to participate in the study.



Thirty patients consented to have blood collected from a peripheral vein via venipuncture and through the PICC line following protocol. PTT, PT, INR, and Fibrinogen tests were run on all samples. Results were compared using Pearson product moment correlations and paired t tests. There were no statistically significant differences in any of the coagulation tests drawn on patients peripherally using venipuncture or samples drawn through the PICC line.



The current policy can be revised to allow coagulation studies to be drawn from PICC lines using an evidence-based protocol.


Implications for Practice:

Institutions that have PICC lines that require heparin flushes or heparin therapy can use an evidence-based protocol to draw samples and assure accurate results.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.