I like to use the 20 g angio that comes in the Bard kits, as it's a bit longer than the standard 20 g angios on the units. I do use buffered lido as I am going at least 1/2 to 1-1/2 cms deep. I approach the vein a bit steeply as with PICC insertions because I need to see the tip at I access the vein. Others might have better luck with a less steep angle, but I'm not good at that.
Usually accessing the basilic 1-3 cms above the AC,but we once had to go way up to the brachio-basilic vein junction in a former drug addict/HepC/liver transplant/morbidly obese patient with NO veins. His veins were so thrombosed from IV meds/IV drug abuse we had to go up high. At that time, we used the sheath from the Cook MST kit (I think) and we got a CT IV tubing hooked up to to. It took two of us 2 hours to get access. I know lots of you will think that is horrible, but we couldn't get a doc to come down, and they (Radiology & liver transplant) really wanted this scan. Not a regular situation.
From: "Tim Talbert" <[EMAIL PROTECTED]>
To: "Nadine Nakazawa" <[EMAIL PROTECTED]>
CC: [EMAIL PROTECTED]
Subject: Re: Re: question about CT
Date: Thu, 10 Aug 2006 10:44:41 -0700
>Nadine, can you describe the technique you use for US assistance with PIV placement? Specifically, do you use a steep angle from the skin like with MST, or a low angle like standard PIV placement? How do you advance?
>
>Thanks,
>
>Tim
>
> >>> "Nadine Nakazawa" <[EMAIL PROTECTED]> 8/10/06 >>>
>
>I'm not saying that the CT must be done without contrast; I'm saying that a PICC is overkill. We can get a 20 g angio in using US in patient with no palpable large veins in the antecub.Nadine Nakazawa, RN, BS, OCN
>PICC Program Coordinator
>Stanford University Hospital and Clinics
>Stanford University Medical Center From: "Cindy Schrum" <[EMAIL PROTECTED]>
>To: "Nadine Nakazawa" <[EMAIL PROTECTED]>
>CC: [EMAIL PROTECTED], [EMAIL PROTECTED]
>Subject: Re: Re: question about CT
>Date: Thu, 10 Aug 2006 08:47:03 -0400
> >If the patient needed the CT with contrast, if it were vital to the
> >health of the patient, if it were my Dad, I would place the Picc and
> >remove it after the procedure. I'd want the best for someone I
> >love.
> >The risk of placing and removing a Picc seems minimal in comparison
> >to
> >the risk of misdiagnosing an acute illness.
> >
> >We have the tools, we just have to look at the whole picture and
> >choose the best course of action. There are not hard and fast
> >rules.
> >
> >On 8/9/06, Nadine Nakazawa <[EMAIL PROTECTED]> wrote:
> >>
> >>If placing a PowerPICC just for CT, you have to look at the total
> >>patient:
> >>Do they really need a central line for anything OTHER than the CT?
> >>Otherwise putting in a PowerPICC and leaving it there is too great
> >>a risk
> >>for very little benefit if they have no other IV access needs.
> >>
> >>Nadine Nakazawa
> >>
> >>
> >>
> >>
> >>
> >>
> >> >From: [EMAIL PROTECTED]
> >> >To: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED]
> >> >Subject: Re: question about CT
> >> >Date: Wed, 09 Aug 2006 22:42:48 -0400
> >> >
> >> >We do the same as Nadine.
> >> >Leigh Ann
> >> >
> >> >
> >> >
> >> >-----Original Message-----
> >> >From: [EMAIL PROTECTED]
> >> >To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
> >> >Sent: Wed, 9 Aug 2006 7:44 PM
> >> >Subject: RE: question about CT
> >> >
> >> >
> >> >No, but we do use ultrasound sound to place a peripheral 20 g
> >>angio right
> >> >above the antecub.
> >> >
> >> >Obviously this is only by someone trained in US.
> >> >
> >> >Nadine Nakazawa
> >> >
> >> >
> >> > >From: "Denise Harper" <[EMAIL PROTECTED]>
> >> > >To: [EMAIL PROTECTED], "listserve" <[EMAIL PROTECTED]>
> >> > >Subject: question about CT
> >> > >Date: Wed, 9 Aug 2006 13:05:32 -0700 (PDT)
> >> > >
> >> > >If you have a patient who needs a CT (that HAS to be power
> >>injected) and
> >> > >you absolutely cannot get a peripheral IV (even with
> >>ultrasound) do you
> >> > >place a power PICC for a 1 time procedure?
> >> > >
> >> > > This question has come up twice today.
> >> > >
> >> > > Thanks,
> >> > > Denise
> >> > >
> >> > >
> >> > >---------------------------------
> >> > >Talk is cheap. Use Yahoo! Messenger to make PC-to-Phone calls.
> >;>Great
> >> >rates >starting at 1ยข/min.
> >> >
> >> >________________________________________________________________________
> >> >Check out AOL.com today. Breaking news, video search, pictures,
> >>email and
> >> >IM. All on demand. Always Free.
> >>
> >>
> >>
> >>
>
>
>
>
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