spastic patient

So your introducer in in the vein but you cannot thread the catheter? Is there blood return from the introducer? Have you assessed the position of the introducer within the vein with ultrasound? Does the guide-wire easily thread through the introducer?

Sometimes with the weird musculature of contracted patients and the weird angles that you have to approach the vessel with will throw off the angle of the introducer within the vein. Normally the flexible introducer will bend and shape to the vein and the opening will point directly down the vein but sometimes that gets thrown off. If for some reason that introducer tip is pointed at a vein wall your catheter can catch on the vein wall or simply bump into the vein. Try pulling the introducer out, slowly, as you try to advance the catheter.

Sometimes the backwards pull of the introducer will straighten things out. Sometimes slowly spinning the catheter while advancing, flushing while advancing, or pulling back the internal PICC guide-wire several cm will also help.

Keep in mind that if your vessel is only 1-2.5 cm deep that you do not need the entire length of 6cm or whatever the length is to access the vein.