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picclineman's Latest Activity

  1. picclineman

    Preventing infections during ultrasound guided PIV

    You can use a sterile glove to cover the transducer with gel on it.. You also use saline flush vs sterile gel, it gives you the same clear picture of your veins...
  2. picclineman

    Making a picc line a Midline

    Has anyone taken the Vascular Access, Board Certification exam? Were the questions really for a board certified vascular access professional?
  3. picclineman

    Making a picc line a Midline

    In the 15 years i have done PICCs and midlines, i have used PICC catheters and trim them to become midlines per INS definition. The PICC catheters are trimable catheters , so i do not see any reason why not. Of course, your rep is going to tell you not to trim their PICC catheters because they need to have more sales... Except if you use a groshong double lumen you cannot trim the catehter. If there is any research out their, i have not encountered any. How are my patients, i have had no adverse report so far. I know, once i had a discussion with another nurse who told me that i should not be trimming the PICC catheter becase she says her rep told her to order midline catheters. She told me that the label of the PICC catheter says PICC Not midlines and this will cause nurses to mistakenly use the line for a vesicant. I said then the nurses should make sure they look at at the kardex or the nurses notes of the person doing the procedure for the tip position or better yet, look at the chest xray film..
  4. The pharmacy that provides IV infusion products usually have their own IV nurses as employees. They earn a salary much like working in a hospital. Most hospitals have their own vascular access team. It is extremely difficult for us registered nurses to get a contract with a hospital.My experinece is that you have to be known to some doctors who can recommend you to the hospital administration of the hospital. If the hospital is big enough, they will tend to form their own vascular access team. The injection business that you are doing now, are you an employee or doing it as a contractor? Going into business has a lot of downside but is rewarding too. If you hate hospital work as i do, you will love it. If you expect money every two weeks like working as an employee, dont do it. I would advice you to do it part time. Keep a full time job and do your business on the side until you grow your census and survive on your own. Keep one foot in the hospital cause you might loose all your contracts and it is difficult to get back once you are out. I hope i am able to give you an insight of someone already inbusiness.
  5. picclineman

    a couple picc questions

    it depends on where the tip of this PICC was originally. If the tip was SVC/RA junction and it migrated 3 cms, you still will be in the SVC area. If you were left sided PICC and the tip was proximal SVC 3 cms will place your tip in the innominate vein. So check the xray first and see where the tip was originally. The PACs usually has a measuring device which will aid you in determining where the tip could be. It would be nice if the catheter does not migrate at all.
  6. picclineman

    Question about drawing blood from PICC lines

    There was an article about blood draws from the INS magazine about changing the caps first prior to blood drawing. Part of the reason wasm the old cap could be harboring bacteria. But yes i think drawing with the use of ten /twelve cc syringe is a better way. Better yet if you can clean the hubs with chlorascrub/alcohol, draw your specimen then apply a new cap after flushing willbe a good practice.
  7. picclineman


    you will still know when your tip is in the jugular vein WITHOUT sherlock or naviagtor. Use your ultrasound. So the sherlock/naviagtor is really useful to help identify your line is in the rpojection of the SVC RA region/contralateral/retrograde. This is also useful for me in cases where i dont want to readjust lines such as combative /confused/severly anxious/ cases where you opnly have one arm to work on.This is probably in my experinece 1% of my population. If not for this and the fact that i have to cater to several hospitals, i probably will not use it. I just got frustrated over one of my cases thw other week where two times i used the naviagtor and it was in the azygous vein. Thanks for your opinion.
  8. picclineman


    How does the sherlock show when the tip of the PICC is in the azygous vein. This is my question. As far a effectiveness, it depends on who pays for it. If i were to pay for it, i will not use it. If the hospital pays for it, i go for it. The only time that this equipment will be totally and convincingly be useful is if its result is acceptable to the medical community. Its a good help in terms of time but not financially helpful. Thanks for your opinion.
  9. picclineman


    I would like to ask the opinion of the PICC experts out there. How does the sherlock system manifest/show when the tip of the PICC is in the azygous vein. I am under the impression that the tip locating machine are directional in nature, in other words it tells you the direction of the tip as opposed to where exactly the tip is. I use the Corpak Navigator Bionavigation System and i have encountered a case where the machine indicated the tip of my PICC to be projecting towards the SVCregion however the chest xray shows the tip is in the azygous vein by approxximately 2 cms. I adjusted this line, but before i retracted the catheter, i used the navigator to see how it would look like ( directional wise). It showed the same as the first time. I proceeded to adjust it and used the navigator which again indicated the tip to be directionally positioned in the SVc region. second xray showed the same with a little difference,but the tip was not too deep n the azygous vein. I have come to a conclusion that the machine cannot really identify when it is in the azygous vein. Hope to hear from somebody. Thanks for your opinion
  10. picclineman


    my point is is it worth spending 99% to solve a one percent problem? You can look at it from different angles. I agree with you that problems happen when you least expect it. But what i am trying to drive at is if the sherlock or corpak wire technolgy or navigation technology is used, the company should back up it s claim. otherwise, if you just keep on spending without really getting your moneys worth t is not practical. I am trying to share my experience with you not to compete with you. What i am urging everybody is to encourage sherlock or corpak to do a study and present it to the medical community so this technology becomes a standard, because in my humble opinion, if it is not acceptable to the medical community, it is not worth the money spent on it.
  11. picclineman


    If we as nurses or bard and corpak cannot use the PICC after insertion with use of the sherlock or corpak, what is the point of using this product. this becomes just an additional expense to the already high expense for inserting a picc. My experience is 99 % of my picc end up in the SVC as long as they advance to my intended lenght. My 1% is azygous, contralateral, coiled on itself. With this situation can i justify spending more for a 1% non SVC placement? The only way i can justify the use of sherlock and corpak is if the report from it can be used as an official report meaning i dont need an xray. I cannot understand why sherlock will sell a product but cannot stand behind its report. It is similar to them (sherlock) saying i want you to use this product but i cannot support you if something goes wrong. i chalenge sherlock and corpak to do a 10,000 patient study, present it to the mdical community and i am convinced they will take this study seriously and hopefully agree to use its report. HOW ABOUT THAT!!