blsmom

Thanks for your response. I found out she had gone home 4 days later and they started using her dialysis cath...she never had a femoral inserted.

Pt. on our unit is a 25 yr. old female dialysis pt. She has a thrombus in her IJ, cephalic, and basilic vein of ® arm. Has fistula in her (L) arm with left hemodialysis cath present. She had a PICC in the right arm 2 weeks ago. Right arm has 4+ edema. Our staff asked for a femoral line to be placed. Instead Dr. wrote for peripheral I.V. to be placed for fluids and her pain meds. She was to have a CT the next day. They were able to place peripheral #20 angio in right arm, despite the major swelling. We felt this was unsafe due to her clots in that arm and the fact you would not be able to tell if line was ever infiltrated...would also sometimes get I.V. Phenergan. Dr. said because Heparin was infusing through the I.V. it was not a problem. Labs had to be drawn either in dialysis or from her foot. Please help shed some light on this problem...Should peripheral line be placed in arm with major swelling and clots in those veins identified above???? Thanks in advance for your help

If the Picc is short and only in the subclavin vein, can some types of chemo still be given. Which ones? Thanks

Have seen experienced PICC nurses do both bevel up and bevel down for PICC insertions with u/s and freehand #20 angiocath. Please shed some light on which way is better? Thanks:uhoh3:

I usually position the pt.'s bed at a 30 degree angle, but I have seen other PICC nurses position higher than this. I am curious as to what other experts use for pt. positioning and whether a higher angle decreases chances of PICC going up the neck. Thanks!

Am I correct in saying that a triple lumen power picc has a higher incidence of DVT risk? What are the risk factors associated between the 5 FR. size double lumen vs the 6 FR. triple lumen cath? Thanks in advance!

Thanks for the tips...I appreciate it!!

I am finding I do better inserting Picc's using no needle guide, just a #20 angiocath and the U/S screen. I feel as though when I use the silver needle in the microintroducer kits my wire can get hung up. I go through the vein and slowly pull back until the blood flows through the angio. I usually try to angle down the angio as I slowly pull back, something I can"t do with the steel needle as well. Any thoughts on this technique? What ways do the more experienced Picc nurses think is the best? I am still learning!

I am very new and learning the ropes to picc placements. I am having trouble seeing the needle on the screen enter the vein. In regards to the site rite u/s machine does the angiocaths show up less than the needle in the microintroducer kits? Any tips greatly appreciated:confused: Thanks

I am just starting to insert PICC's. Our facility uses power picc's and pasv's. Most everyone uses a #20 angio under u/s. A few use the steel needle that comes in the kits. I can access the vein with the #20 but sometimes the guidewire will not thread and comes out bent. I will try next time to lower the angio to be flush with the skin to facilitate the guidewire going in. Sometimes I feel the angio is so flimsy...but the caths in the kits are to stiff...any suggestions????????????????? What does work the best? What do you use?? Thanks

I am still in orientation with regards to placing PICC's. I heard a ICU nurse say a patient was not a canadiate for picc placement because he had a + BLOOD CULTURE for strep. I thought all the more reason for him to have long term antibiotic's and a PICC line. But I am new at this...I need an experienced PICC nurse to shed some light on the right answer. Thanks!

Just curious about this as a vein finder. Does it work? Are there better ones on the market? Or does the ole fashion way of palpation work just as good!

I was wondering what is the average time it takes to insert a PICC line?

Has anyone heard of Infusion Knowledge and instructor Mickey Hawes? They have a class coming to my area that I am interested in. I have been a working R.N. for 25 years and frequently do the difficult I.V.'s at night. I would like to become PICC certified. After I become better at this I would think about home care...is there a need for this? Does it pay well? What is the best way to get established? Thanks