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You are so correct Lynn.
It helps to really "twirl" the introducer sheath
into the vein. If I am unable to do this, and I know the sheath is past
the point of skin entry, I wait it out a few minutes. Busy yourself
with trimming the catheter, gathering sharps for disposal, etc. When I go
back to the patient the sheath invariably slides smoothly in. It does no
good to try to force it in, as you will get more venospasm and a painful
procedure for your patient.
Another point - when "dilating up" (passing the
dilator over the wire first), I let it rest there a few seconds. Moving
the dilator in and out of the vein will not dilate it any better, and more than
likely cause more trauma and venospasm.
Nancy Costa CRNI
----- Original Message -----
Sent: Monday, October 30, 2006 8:23
AM
Subject: RE: ? Problem with
introducer
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
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--
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
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