At our hospital we are called on occasionally to place peripheral IVs using the Bard Site-Rite 3, and I have done about a hundred or so of these. You can use the site-rite just as you do to start a PICC, but it is more difficult for three reasons.
reason #1: Difficulty threading: when doing a PICC if the IV catheter doesn't thread up the vein it is usually ok because you can usually get the wire to thread and thats all you need. If you are starting an IV you do need to get the IV catheter to insert fully. You MUST use an IV catheter that is 1 3/4 long (20 gauge); the regular length catheter (1 1/4 in) is simply too short to reach. I think all manufacturers have the longer catheters. reason #2: infiltration: For more than short term use an IV in the upper arm seems less than satisfactory. I think its because the normal movement of the arm causes a lot of movement and pistoning and then infiltration. That is not a problem for PICC/Midline because of the flexibility of the catheter and the fact that it is impossible to fall out of the vein. So for a peripheral IV that needs to be there 72 hours I prefer to start it in the lower arm, just distal to the antecubital space. The veins in that area are often adequate size and the IVs seem to last longer. However, since the veins are not as big as the upper arm it does take more skill and luck to get it in, so in some ways it is harder than doing a PICC/midline. With the smaller veins it is very easy to go through the other side, so it takes some practice to get it just right. Sometimes when I go through I pull back until I get blood return, then advance it into the vein; that usually works. #3. Sterile technique: we don't use a sterile needle guide or cover. Instead I find the vein with the bare probe and gel, then mark the spot with my pen with the point retracted, or a straw. Then I prep w chloroprep and use lidocaine if desired. Then I place a small bead of gel above the site, then insert the needle. If you are careful the probe/gel will not come into contact w the needle site. There is no need to wear sterile gloves--just as in a regular IV stick. Some people use sterile gel; I use regular gel since it doesnt (usually) come into contact w the catheter. Rich Pearson RN MS CCRN Clinical Nurse Specialist Intensive/Post Intensive Care Alegent Health-Immanuel Medical Center 572-3433 >>> "Lawler, Maureen C." <[EMAIL PROTECTED]> 5/16/2006 1:15 PM >>> We are just beginning using US for PICCs. Ct Scan does not want to use power injector on veins in hand or wrist...don't blame them. If they can't gain access in a large vein they call us and sometimes we can't either. They have asked if it would be possible, once we gain skill with US, to place periphs in the upper arm with the aid of US. Are any of you able to do this and if not what do you do to gain access for CT power injections?
