Re: ? Problem with introducer

Mon, 06 Nov 2006 23:05:51 -0800

I also found gently using twisting motion (like screwing in a light bulb) helps. If the introducer gets frayed out it might be better to get a new one to reduce the trauma to the vein wall.
Michael Drafz

Nancy Costa <[EMAIL PROTECTED]> wrote:
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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Michael Drafz RN, OCN, CRNI
Clinical Lead Vascular Access Service
Sharp Memorial Hospital Metropolitan Campus
San Diego, California

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