I recently was called to place a PIV in a pt had a case of shingles on his face. I had to use US d/t no palpable or visible veins. The intial skin poke was benign. It wasn't until I got close to the vein that the pt began to c/o intense pain. (I was going for a vein in the forearm.) I left my catheter in place and called for some buffered lido. I injected the lido at the depth of the vein, about .75 cm. I was then able to advance my needle into the vein without any complaints of pain from the pt. This has happened before with PICC insertions but usually when cannulating the brachial veins and only a few other times with PIVs. I consider that maybe the increase in sensitivity was d/t his already hyperactive nervous system from his condition.
Cat Johnson RN
From: "Nadine Nakazawa" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: RE: Catheter length exposed--evidence or opinions?
Date: Sat, 12 Aug 2006 10:28:27 -0700
>
>We always adjust the PICC tip so that it is at the caval-atrial
>junction or deep distal SVC. We place the wing 1.5 cms away from
>the exit site and suture to one side, placing a steristrip over the
>wings. Then we use Statlock on the hub portion. We're doing that
>with the PowerPICC as well for consistency sake. It's easier for
>the nurses to change the PICC dressing with similar landmarks. We
>also allow for enough PICC externally to advance if our external
>measurements are off. We will it's more important to have the tip
>correctly placed, and allow for the adjustment to be outside the
>skin.
>
>Nadine Nakazawa
>
>
>
>
>>From: "DAVID LONGSETH" <[EMAIL PROTECTED]>
>>To: [EMAIL PROTECTED]
>>Subject: Catheter length exposed--evidence or opinions?
>>Date: Sat, 12 Aug 2006 10:11:34 -0500
>>
>>The majority of the PICCs I place are Bard's Groshongs,so I have
>>only two lengths to choose from. I always try to measure accurately
>>enough to leave out more than 1.5cm (to accomodate the Biopatch
>>under the dressing) and less than 5cm (to take advantage of the
>>tapered end to plug the vein and the tract). Due to differences in
>>patients' anatomies,it doesn't always work out that way but I try.
>>Does anyone have any thoughts on the matter?
>>Thanks
>>David
>>
>>
>>
>
>
>
