Hi all PICC RNs,
I got a lot of useful information from this site. so thankful !Would someone tell me how to access deep, small vein using ultrasound during PICC insertion ?Any input is greatly appreciated ! Thanks a lot !
Are you a current PiCC nurse? Which vein, basilic? brachial? how small? did you measure it? is it an appropriate size vein to have a line? Is the depth due to excess tissue?
Hi Zoidberg,I am a PICC RN . any vein, basilic, brachial.It is big enough to place 4 FR but half size than regular vein . The depth is due to excess tissue . Thanks
you will need an extra sterile pair of hands to pull the skin tight and the tissue out of the way.The pressure on the pt's flesh will reduce the depth of the vein so you can reach it with your needle. Once you access the vein you don't release pressure until you have the wire in the vein. Once you are ready to place your dilator you need to remember that your dilator is only so long. Once you're in the vein and you have pulled out your wire don't release the compression of the flesh. Hold that dilator compressed in the flesh especially once you remove the inner portion of the dilator until you pass your PICC line into the vein.
Thank You so much Zoidberg RN!
With the smaller veins, depending on assessment, I'll access the vein a bit closer to the AC area than I normally would since it's a bit more superficial. I always use the 1.75" IV cath that comes in our kit so I can cannulate and not worry about losing access. Sometimes with the smaller veins it's also helpful to decrease the insertion angle to prevent going through the vein.
Thank you so much MikeyT-c-IV RN!
How deep are the veins you are trying....greater than 1.5 cms below the skin.Can ypu tell me the exact problem...are you going through them...missing altogether......nicking them....running out of needle..are you measuring the veins without a tourniquet to make certain the catheter to vein ratio is less than 45 percent...be very specific so I can be very helpful.Do you have any special gudewires for the obese population...We use an awesome one that we add on to the field..bc once you access the vein you don't want to lose it because of the gudewire.
HI Dear Iluvivt ,
Yes, The vein is deep greater than 2.5cm below the skin . I measure vein with tourniquet on . The vein diameter is 0.75 to 1cm . First ,I thought the vein deep, my needle angle would go deep . I could not see my needle . I guess my needle and probe not cross. I adjusted my probe but I forgot how did I do it . I saw my needle right way until guide me to the vein .would like to learn more how can access the deep, small vein using ultrasound ? thank you so much !yes. We do have special wire called body wire .
"Big enough for a 4FR but half the size than regular vein"... Not sure what that means as far as what is considered a regular vein.... How small of a vein are you talking about? My first question would be what the PICC to vein ratio is to ensure that you should even be accessing the vein for PICC placement. Remember, the smaller the vessel the more limited the flow when you slap a PICC into it. Also, it is prudent to look at the vein without the tourniquet.
I have a question about PICC lines as well. My home health patient called and said her PICC line came out a little. It was at 5 and now she says it is at 10. She is an RN also and stated she checked for blood return and it returned well and then flushed well with NS. Should I be concerned and call her doctor or is it ok since it is drawing and flushing easily? Thanks so much.