Your comments are similar to what I have heard from others. While US
may increase the initial success rate of getting the catheter into
the vein, there is no data on the outcomes with that catheter. For
one person performing the procedure, it is impossible to use the
recommended venipuncture technique calling for one hand to hold the
catheter and one hand to hold skin traction. You would need a 2nd
person to hold the probe in order to use this standard venipuncture
technique. When you can not hold skin traction during the
venipuncture and complete catheter advancement, the vein will
naturally move around as you push the catheter. This causes the
catheter to contact the vein wall leading to phlebitis or
infiltration.
I would strongly caution everyone though **not** to use the
double-wall technique to go through both sides of the vein, pull out
enough to reach the vein lumen, then thread the catheter into the
vein. While this may work for a PICC, it is the perfect way to cause
infiltration or extravasation injury with a short peripheral catheter
and these types of injuries are the most frequent cause of lawsuits.
Lynn
At 2:44 PM -0500 5/16/06, Richard Pearson wrote:
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?
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
