Quote from Gail-Anne
Did you learn to place only by palpation or always use U/S? Are you having trouble with a particular vein? Cephalic is more likely to have trouble than Basilic (having said that- I've had about 6 people in the last couple of months that I couldn't thread Basilic and had no problem with Cephalic!) What technique do you use? I use Modified Seldinger. Do you have trouble mostly with introducer, threading guidewire or catheter? I use bevel up, if I have trouble with threading guidewire then I likely spin it. Also, do you get sedation for most people, can make quite a difference with venospasms.
Don't know that I've helped but, if you have more specific info I'll try again if I have any suggestions.
I find it just goes in runs sometimes. The person you expect to be easy won't thread----then 3 drug abusers in a row with @#!* for veins and they thread easy. Go figure! To quote another PICC nurse "this job really humbles you"
Actually learned years ago by palpation, but the hospital never allowed us to actually insert the PICCs (they sent us to the class, but never allowed the skill...go figure). Now am using U/S, with mod. Seldinger. I have had several times where I get the needle in, but can't advance the guidewire even with lowering the angle of the needle and twisting the wire. Also have had a couple veins which appeared to "blow" right there on the screen, lovely.
The nurse who taught us demo'd inserting the needle bevel down, and at nearly a 90 degree angle, which we are having trouble with. One of the U/S techs recently showed me why this acute angle of entry bites, since you can't "see" where you are.
What are you using for sedation?
Anyway, I keep wanting to relate PICC insertion to my peripheral IV experience. I rarely miss a peripheral stick, so missing these PICCs is really burning my butt. And my brain tells me that bevel up makes more sense, as well as a lower angle. I even watched a Rad using a longitudinal view on U/S while he advanced the needle. I know that I can do this, I just hate having the failures that I punt to IR.
Thanks for your help!