PICC insertion with U/S

  1. I work alone, in hospital, inserting PICC's at bedside. I was inserting by palpation until getting an ultrasound (SonoSite) a couple of months ago (with little training). I'm getting the hang of catching the Basilic vein, still having some trouble threading guide-wire with deeper veins and increased angle. Biggest frustration at the moment is inability to thread catheter past 10-15 cm. I'm wondering if it has to do with the increased angle now that I'm dealing with deeper veins. Any suggestion? Thanks
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  2. 4 Comments

  3. by   CritterLover
    i actually haven't had that problem. if i can get the guidewire in, it is pretty rare that i can't get the catheter to thread for the basilic vein. now, the cephalic is a different story. i often have a hard time getting the catheter past the cephalic/subclavian junction due to bone interference.

    i have had a problem with the steep angle in getting the guidewire to thread when the veins are deep and i have to go in at a steep angle. have you tried sticking a little (1-2cm) distal to your selected site? if you do that, and use at least a 1 1/2 inch catheter, you should be able to approach at a more shallow angle.

    hope this helps some.
  4. by   PICC chic
    Quote from Gail-Anne
    I work alone, in hospital, inserting PICC's at bedside. I was inserting by palpation until getting an ultrasound (SonoSite) a couple of months ago (with little training). I'm getting the hang of catching the Basilic vein, still having some trouble threading guide-wire with deeper veins and increased angle. Biggest frustration at the moment is inability to thread catheter past 10-15 cm. I'm wondering if it has to do with the increased angle now that I'm dealing with deeper veins. Any suggestion? Thanks
    I was wondering if you use a needleguide, sometimes in the beginning using a needleguide can help a whole lot with getting in at the right angle. I know that sono-site does have a probe cover with needleguides.
  5. by   Gail-Anne
    Don't use a needle-guide, but my understanding of them is that they're for accessing vein only. That's not where my troubles lie.
    I think the answer is to persevere! I've been placing PICC's, with a very high success rate, for a couple of years by palpation. Frustrating to be poking extra times with ultrasound. Mostly it's going fine though. Thanks to both people who responded.
  6. by   JACK_E
    Our facility just purchased a sonosite for ultrasound guided placement and I was wondering if anyway had a policy for this procedure. I could make one up BUT it has to be evidenced based ( with in the last 4 years)..Can anyone help?????

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