We do that frequently here. Often you can locate excellent veins in
the forearm less than a centimeter deep. When the pickings are slimmer,
we access either the cephalic or basilic veins of the upper arm. There
are a couple of ways to do that. If the vein is not too deep, I press
the retracted point of my pen into the skin over the vein at two points
about an inch apart, guided by ultrasound. This makes little dimples in
the skin that can be scrubbed without being washed off. I then use the
marks as a guide to do my stick.
For deeper veins, I use ultrasound to watch the process as I
would when placing a PICC. One expensive, but very successful trick I
have used a lot for deeper veins is to use a #20 guage Arrow radial
artery catheter to do the stick. It has a guidewire mechanism built
into it which you can thread into the vein as soon as you get a blood
return. Then it is fairly simple to thread the catheter. My
first-stick success rate with this technique is probably better than
85%, which makes it cost effective despite the $13 cost of the catheter.
Jerry Bartholomew RN BSN CRNI
Vascular Access Specialist
Veterans Affairs Medical Center
Spokane, Washington
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Lawler, Maureen C.
Sent: Tuesday, May 16, 2006 11:15 AM
To: [EMAIL PROTECTED]
Subject: Ultrasound for periphs
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?
