From: "Nancy Moureau" <[EMAIL PROTECTED]>
To: "'Gwen Irwin'" <[EMAIL PROTECTED]>, [EMAIL PROTECTED]
CC: [EMAIL PROTECTED]
Subject: RE: Do you notice the patient's reaction to vein entry?
Date: Sat, 12 Aug 2006 14:44:38 -0400
One thing that is consistently different from RN bedside placement to IR
placement of PICCs is the volume of lidocaine used. Those with IR
experience
use an average of 1cc sometimes up to 2cc going deep and infiltrating back
to the surface. This level of anesthetic action cuts down on the small
nerve
branch issues and make smooth sailing for the insertion and the patient
controlling the pain well. My conclusion, we need to start using more
lidocaine and stop being weenies with the lidocaine and give an adequate
amount. I hear what you are saying, Gwen, with the different types of
patients, those more sensitive near and around the vein, but maybe we could
help them have a bit more lidocaine and a much better experience. Maybe all
they need is adequate anesthetic...
Nancy Moureau, BSN, CRNI
PICC Excellence, Inc.
888-714-1951
<http://www.piccexcellence.com/> www.piccexcellence.com
<mailto:[EMAIL PROTECTED]> [EMAIL PROTECTED]
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]
On Behalf Of Gwen Irwin
Sent: Friday, August 11, 2006 9:25 PM
To: [EMAIL PROTECTED]
Subject: Do you notice the patient's reaction to vein entry?
This may seem to be a weird topic, but with our years of ultrasound
insertion of PICCs, we have noticed that some patients really react to vein
entry BEFORE we are close to entering the vein, while observing on
ultrasound the location of the needle in relation to the vein wall. When
we
proceed past that point, we are in the vein with excellent blood return and
proceed to successful PICC insertion. Local anesthesia works only on the
skin entry and doesn't prevent this reaction to vein entry. They also
react
differently to vein entry of the dilator/sheath introducer.
This population of patients are also the ones that complain of the most
pain
with IV insertions. Most staff nurses give up before entering the vein
with
an IV catheter, when the patient complains of this pain. If we are called
to do a PIV, we don't give up at that point, but believe that we are right
on top of the vein and continue past the patient's complaint to vein entry.
We have a successful PIV.
This is so hard to measure for a study, but our observations have led us to
believe that the innervation of the exterior of the vein is different for
some people. We don't seem to see a large percentage of our patients that
have this type of reaction, but it is noticeable, when it occurs. Some of
these people call themselves "weenies" for IV starts. Based on the years
of
our observations, we don't believe that they are weenies, but that they
have
different innervation that actually gives them a pain signal before vein
entry. We have been known to tell them that they have bad luck with their
veins, since they feel the stick into the vein before it actually occurs.
These also can be the patients that have more vasoconstriction observed on
ultrasound, during PICC attempts. We have waited for as long as 10 minutes
to observe the vein stop its vasospasm, and see the dilation that we
initially saw on our original assessment.
I am wondering if anyone else is noticing this phenomenon. I am really
thinking it would be useful information to share, but don't know how to
study or report this subjective observation.
I would love to hear from you, if you think we are crazy or if we are
noticing something that has not previously reported or discussed. We have
seen it so many times that we don't think we are crazy. Your responses are
always appreciated.
Gwen Irwin
Austin, Texas
