New PICC nurse needs help......PLEASE
- 0Apr 13, '10 by LCLARNI have just begun my journey as a PICC nurse, I have only attempted 4 with a 50% success rate. I am very frustrated and am starting to doubt my ability to do this. I am using the US for guidance. I have a few questions for some seasoned PICC nurses.
1. On my last attempt I hit the brachial artery. It was very apparent both on US and by blood return that I hit her artery. So I immediately pulled it out of the arm and held pressure. Was the correct? Or could I have just pulled out of the artery and try to hit the vein? I had only this arm to use because the patient had a PICC pulled out of the other arm just that morning. Which leads me to my next question....
2. How soon can you re-access a vessel once a PICC was removed. It was removed because they thought the patient was going home on hospice, not because of infection. The MD is wanting me to attempt it again tomorrow, but I'm not sure what to do?
Any help is greatly appreciated...I'm so happy to have come across this site.
Thanks in advance.
- 1Apr 14, '10 by GailAnneDo you mean that you have only tried 4 PICC insertions total? If so, aren't you still working with an experienced PICC insertor?
Yes, you are correct to remove needle from an artery ASAP and hold pressure for quite some time (10 minutes can be used as a guide).
To be frank, I'm concerned at someone trying a Brachial vein, with little experience, unless they have confidence that they can access the vein without difficulty. I'm not trying to put a damper on your PICC inserting, however, worse than bruising can occur when in the Brachial bundle.....like permanant nerve damage.
Do you not have some Medical Intervention available for back-up? If this person only has a Brachial vein to use, not Basilic or Cephalic, that may be best.
Using the same vein immediately may not be ideal, however, we deal with reality, not ideal. As you said, PICC was removed as it was thought to not be needed, not due to infection or thrombus, so placing it in the same vein may be necessary.
By the way, when accessing the Brachial vein, it sometimes works best to enter a bit to the side of the vein (away from the artery and nerves of course) and then angle over into the vein.
Hope that helps.
- 0Apr 14, '10 by LCLARNYes, this was only my 4th attempt. At our hospital we did not have anyone trained to insert PICC lines so several of us went through a class to be checked off by a physician who was also in the class.
I did not attempt the brachial vein, I was attempting the Basilic, however this patient was elderly with poor veins. I saw the artery on the US and moved up and away from it prior to the stick, but her skin was so loose.....I don't know how it happened.
Anyway, I attempted again today on the left side and was successful!
Thanks for your help!
- 0Apr 20, '10 by piccmeI've only been putting in PICCs for a year. I have put in over 500 in such a short time....and we're a small hospital. The need is just so great. I would recommend calling Bard.... they come out, free of charge and work with you for as long as you need them. they follow up regularly and are a great assistance! In time, you will be a great picc nurse! Hang in there..... its worth the effort every single day!
I have placed in Piccs in patients that have pulled theirs out in the same arm without a problem at all. I have also used the brachial vein when necessary, I, actually, don't find it all that difficult anymore. I use what is there. We arent placing piccs in people who have good veins, hence the great need. You use what is there, in reality.
Take your time, read a lot, have confidence in you! You'll get there.