Questions for PICC nurses

[blsmom]

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

[PICC ACE]

If the wire comes out messed up,the most likely cause is that you weren't in the vein to begin with.

I rarely use an angiocath,and especially not with US. If the vein is very shallow (less than 0.5 cm depth) I will sometimes use a 22ga angio. (Your guide wire should fit through a 22ga just as easily as a 20.)

Normally I use the needle from the microintroducer kits,have a 98% success rate and the motto 'one stick,one PICC'. When I do training I don't teach the angiocath method. The angle used to access a deep vein for a PICC is different than what you normally use for angiocaths--closer to a 45 to 60 degree angle. Also the average angiocath needle does not show up as nicely on the US screen as does the straight needle.

One thing you might be doing is not advancing the angiocath into the vein sufficiently. IOW you get the needle tip into the vein but not the angio--you'll see a blood return but the wire will just ball up outside the vein.

What works best? I think most people use the needles. One important thing to remember is that if you can't advance the wire through the needle,you CANNOT pull it back out--you risk shearing off and embolizing the end of the wire.

Good luck and happy PICCings.