A way to be successful with these patients if to take a washcloth and fold
it in half and then roll it up. Use that washcloth as a pressure point over
the area that you are attempting to access for your PICC. If you hold it
for about 2-3 minutes you can displace some of the edema from the tissue.
The rolled up washcloth gives you a larger work area . Thus allowing you
better access. Now, when you do this prior to cleaning the arm and
inserting your PICC you need to work fast to access the vein prior to the
fluid moving back into the immediated tissue.
You also need to slightly alter your approach and anchor the tissue below
the site or have someone gown/glove up and help stabilize the tissue. This
also helps.
If you use a tourniquet I would suggest one of the wide stretch ones. They
should be about 1in or more in width. They stabilize things better. Nancy
sold one for a while and some of the other PICC companies had some as
handouts at several conferences.
I used this technique when starting PIV's in patient's that were edematous
and when you displace the fluid the veins are there. Same principle for
PICC's. You will need to use the needle on your MST kit to reach the some
of the vein for these attempts, although when the fluid is displaced for a
bit you can sometimes use the angiocath.
If this doesn't make sense, feel free to contact me via e-mail.
Betsy Harmon RN CRNI
Vascular Access Team
Critical Care Unit
Alaska Native Medical Center
Anchorage, Alaska
[EMAIL PROTECTED]
----- Original Message -----
From: "Nancy Moureau" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>
Sent: Sunday, April 30, 2006 11:03 AM
Subject: Edematous Arms and low success with PICCs
I am posting this for someone having difficulty with PICC placement with
very edematous patients. Can anyone offer words of wisdom?
"We are having great difficulty with our PICC insertions on patients who
are
quite edematous. We are using ultrasound, and have been for quite some
time now. We are noticing that when we use a tourniquet on these
patients
the veins are very difficult to see, and seem to move about as we try to
access them.
Is the tourniquet increasing the amount of fluid around the veins? If we
try it without the tourniquet, it is very difficult to see the veins. The
depth is also an issue.
Do you have any advice that could help us out? We have a very poor success
rate with these particular patients."
Thank you
------------------------------------
Nancy Moureau
President
[EMAIL PROTECTED]
302 Hollywood Forest Dr
Orange Park, FL 32003
tel: 1-888-714-1951
fax: 904-264-6887
www.piccexcellence.com
------------------------------------
