I also believe it is not just the introducer. The guidewires are a major problem, much to flexible. I believe we should all be using Nitinol wires. They are less flexible and help guide the dilator/introducer into the vein and is a little more forgiving if we are not following the needle path down to the vein.
Tim Royer, RN, BSN, CRNI > One potential explanation for the vasoconstriction is the frayed > introducer. This increased trauma stimulates the tunica media to go > into contraction. The smooth muscle can hold this contraction for > long periods and it does not take very much stimulation to set it > off. Just a thought of what might be happening when the tip of the > introducer becomes frayed on insertion. Lynn > > At 8:53 PM -0800 10/29/06, Glenn and Dayna Holt wrote: >>I have had this trouble off and on. I find if the skin is thick or >>the nick is not sufficient then the introducer is likely to fray a >>little. Once it has frayed it is nearly impossible to insert. I >>have found that by gently twisting the introducer as it enters, and >>going slowly, I can usually prevent any fraying and the introducer >>goes in easier. I have this trouble more with the 3fr than with >>bigger introducers. >> >>Dayna Holt, RN >>Children's Hospital >>San Diego, CA >>-----Original Message----- >>From: [EMAIL PROTECTED] >>[mailto:[EMAIL PROTECTED] On Behalf Of Susan Fullana >>Sent: Sunday, October 29, 2006 3:41 AM >>To: Nancy Sullivan; [EMAIL PROTECTED] >>Subject: Re: ? Problem with introducer >> >>Nancy, >> Try this: Separate the introducer into two parts. Slide the >>grey part in and out a few times. Then, put it back together with >>the black part and attempt to insert. This is how I perform all of >>my MST PICCs and most of the time I totally avoid the need to use >>the scalpel. >> >>Nancy Sullivan <[EMAIL PROTECTED]> wrote: >> >>My question for the day. We use Bard introducer, with groshong >>piccs. In the past two weeks, it seems I have been having an >>increasing problem with getting the introducer into the vein. No >>trouble accessing the vein or threading the guide wire, but when it >>come to advancing the introducer through the skin, I have been >>having major problems. Small nick in the skin, able to get light >>gray part into skin and then I hit the brick wall. Haven't changed >>my technique. At first I thought it was just the large fatty arms, >>with deeper veins, but last evening, the last two piccs placed, >>presented me with this problem. Is anyone having this problem now >>or in the past? Any suggestion as to what my problem might be. I >>probably have a 99% success rate with picc insertions and this >>problem is troubling me. Thanks for any suggestions and for your >>time as I ramble on. >>Nancy Sullivan RN >>__________________________________________________ >>Do You Yahoo!? >>Tired of spam? Yahoo! Mail has the best spam protection around >>http://mail.yahoo.com >> >> >> >>Susan J. Fullana > > > -- > 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
