PICC Insertion pointers

[AmyEkstrand]

Hello all! I have recently started inserting PICC lines at our hospital. I have been successful in inserting 7 out of 8 but have had similar nurses run into the same problem that I had with my first unsuccessful insertion. Would you guys be able to help me out? When I access the vein with a catheter and pull the needle out we are taught to have a nice dripping flow of blood. Then we are asked to insert the guide wire and thread it. As I thread the wire, I meet resistance and it wont thread any longer, so I would take the wire out and try again. But now Ive noticed that I no longer have a steady dripping flow like before. Im wondering if you have any tips on why this would happen or if we may be doing something wrong as another coworker of mine has had this happen a few times. Im assuming it means that the vessel may have collapsed or ruptured but am looking for some seasoned nurses to help me out. Thanks!! Amy RN

[IVRUS, BSN, RN]

Most likely you are blowing the vessel. Make sure your getting a brisk flashback in your stylet and that your angle is not too steep. Once the flashback occurs, drop that angle and advance a couple of mm more. then remove the stylet and blood should be pouring out, then use your guidewire. Are you using US?

[yrmajesty3]

Hello Amy, I am just beginning my PICC training. I'll be visiting often to read responses to your question as I expect to be running into the same type of problems when I finally make my first insertion attempts. My first thought to your dilemma is spasm. Is that a common problem and does it present the same?

[HMarie13]

I know this is an old post but ...

If you are using ultrasound make sure to visualize the catheter tip in the middle of the vein. Sometimes you get good blood but may be on the edge so when you attempt to advance to can't because of the tip location in the vein. I never advance the wire based on blood return only. I have to see the white flash of the needle tip in the center of the vein first.

Make sure to drop your needle angle before you attempt to advance the guidewire. If your needle is at a 60 degree angle or so the wire my not bend well enough to easily advice.

Last suggestion (one again if using ultrasound) watch the pressure you put on the probe of the ultrasound. If you are compressing the skin and tissues around the vein with that probe, when you let off to advance the guidewire the needle tip may back out of the vein. I've noticed this with patients that have deeper veins, I catch my self compressing to make the vein more shallow.

[Infusion50]

Thank you soooo much for those pointers HMarie!!! Your tip about being careful with the probe pressure was especially helpful. I have had about 10 successful inserts so far. But for several times I could not advance the wire even though I SWORE I was in the middle with great blood return, I never considered the probe pressure issue. It all makes sense now!