HMarie13

I always avoid the basilic vein when placing a PIV - that vein may be needed for a PICC, it's generally to deep for a regular PIV and the path isn't always appropriate for a PIV (as mentioned above in posts). Even if your using a longer catheter the catheter may still be a little short for the vein of choice. So it depends on how straight of a shot you get into the vein. Example - If you stick a 1cm deep vein at 45 degree angle approx 1 cm away from the probe (which is proper technique) then it will take 1.4cm to reach the vein. Best practice I believe is to have at least 1/2 - 2/3 the catheter length in the vein. With that perfect stick/straight shot it is already almost 1/3 if you catheter. ideally you would have the other 2/3 of the catheter in the vein. So imagine if it wasn't a perfect straight shot, you really don't have much wiggle room and that's at only 1cm depth. Ultrasound IVs are difficult. Not only are the they toughest patients to stick the skill it's self take time to perfect. BARD has a good ultrasound video and I think sonosite does also. The best thing to figure out what exactly is happening to cause complications is going to be learning more about it. Not just he skill but the didactic education too.

If the facility has a nurse recruiter or a specific person handling the interview process I would try and speak with them. Don't say "I want this job" ask "What can I do to better my chances of getting this job". Ask them if you can improve on anything specific so the next time you can be more prepared. I also agree with some previous comments. Sometimes they interview but already have a person in mind who has demonstrated they would be a good fit for the job. Try to help out with any educational projects you can! That will not only give you experience but it will also make you more known. Good luck! I hope it works out for you!

I do not teach so from a students side...I did learn about percussion during my ADN and BSN program. I never used it during bedside assessments but I do think it is helpful to learn just so you understand the concept. Also you understand when a physician is doing it and can explain the reason to your patients if they ask.

Thanks everyone for your comments. I am seeing it varies greatly among different facilities.

Thank you Maritimer! Yeah we do not use heparin on the Groshong PICCs, but out ports are PowerPorts...They require heparin its just an issue of how to word how often to use it.

Yes thank you Wuzzie. I am just trying to get of feel of how others utilize heparin.

Hello everyone! I wanted to get information on others policies...I have found some online but thought this would also help. I have to update our flush protocols and need to know what other hospitals do and have articles to back it. So far I have found nothing in INS but I am still looking. Any other places good to check? When accessing an implanted port, do you waste the first 5mL of blood removed to discard the old heparin or check for blood and flush the line? How often do you flush with heparin? Every 12 hours? After medications through out the day? After blood draws? Contrast? Thanks for any responses! Our educators are skittish because of HIT and don't think we should use heparin. I asked our sales rep for the port brand we use and they suggested "per hospital policy"

Those numbers are awesome! I just don't understand why our numbers are so low?!?! As far as I know even years ago when the nurse was "busy" she was placing maybe 800 a year. I actually do currently do rounds on all central lines, offer to do PIVs, assess the need for central lines and removal of femorals. It usually gets me a little business but not much. The problem is that only part of my job that counts towards productivity is actual PICC placement. Thank you for you information and advice! I will keep on and hope it helps!

Yes true! I get on to my nurses all the time for not classifying PICCs as central lines....Now there I go doing the same!

Just looking at this again! I have been busy with my BSN, thank you! I will look into it I am a member of INS.

I just wanted to see other hospitals (similar is size) PICC numbers are. I am a 1 person vascular access department, I work bankers hours. We usually have about 250-290 patients in house. I am not trained on pediatric. Last year I placed about 600 PICCs (average 35-60 month) and a little over 1000 PIVs. I am constantly being asked to increase my numbers...but HOW?!?! When a PICC is ordered usually the only lab level that will prevent me from placing in the kidney function levels. The patient has to be on at least 2 vesicants. When I get a call for a PIV if it is not an emergency situation I assess the need for PICC first. We have had our sales rep come in and talk with the physicians, I have talked to each group of our residents. Please, any ideas would be great! I need to increase my numbers to keep my position.

I love this! I often have wondered if I could ever be trained to place central lines. My biggest criteria issue is renal patients. Placing traditional CVCs would resolve this issue. When you say mentor, who is that? We have Critical Care physicians but we do not have a doctor in the ICU at all times.

Thanks y'all. I never would have picked the DVD just the book but sounds like I may need too. No study partner, it's just me. I am trying to talk our infusion nurse into getting hers with me but she is working on her chemo certification right now.

I am wanting to get my CRNI. I took the VA-BC test and it was not that difficult but I have heard CRNI is more difficult. Does anyone have any tips? Is the study guide enough for the test or should I get more information beyond that? I am taking classes for my BSN right now so I haven't even got the study guide or started studying yet. I was just wondering what I am getting into! :) Thanks!

Finally took my VACC! Went well so far have not received the official results yet. They now have practice questions avaiable on the VACC site! They were pretty basic but helpful to see the type of questions! Just leaving this for the next person passing through :)

So I never had any interest in becoming a NP until I started placing PICCs at bedside as an RN. Now I have a huge interest in Radiology/IR NP but I have no idea where to start. I am currently going to school for my bachelors but am wondering if I should change over to NP program. What all education is needed besides the NP program? Radiology/IR certifications? Any information would be great. I've seen a few posts but they are from years ago. Thanks!

I have only used a few 18ga, mostly the 20ga. I feel like I assess the vein fully it seems after a day or two they quit functioning properly. I will watch closer of the vein before placement and see if that helps. Thank you!

Same here as comment above, I use 1cc at a time. Comes in handle to have the whole 5cc if I need to stick a second time I have more available or in the rare occasion I suture.

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.

If you can get trained do it! I love placing PICCs. Heads up though getting on PRN somewhere will probably be difficult if you don't have experience. It's not something you perfect over night. Most places I've seen want experiance, I would keep trying!though!! One thing that might help is learn what you can about PICCs/CVCs on the book side...read hospital policies, procedures, online articles about caring for PICCs just anything about vascular access placement/care. I honestly feel they helped me. I thought I knew a lot about them from a nurse standpoint but once I got in the position I realized I didn't know hardly anything !

Has anyone used bards midline/extended dwell PIV the PowerGlide?? I have a love hate relationship with it, I love the idea hate the product. (Ok not true hate but I'm aggravated...) Seems they always clot or kink. Anyone have any tips or experiences they can share with me?

There are programs that offer RN-MSN/FNP. That would allow you to start working sooner. I don't know which way is faster or cheaper but it's an option.

Thanks so much !

Well I hope your results are positive :) i have not taken it yet, I want to take it in December. I started in vascular access this past November. I am hoping that my few years of nursing experience covers my other year of dealing with vascular access. The main part that worries me is over dialysis catheters, I don't deal with them often.

Yea that's how I've heard of nurses doing it in the past. Just ok for use but the radiologist still reading the X-ray. Thanks so much for the links !!