Starting PICC lines, getting discouraged

Gail-Anne · Dec 29, 2005

Are you inserting on babies only, or did you get a chance to do quite a few adults first? And how many insertions did you do with a mentor?

Any particular point of insertion that seems to be the failure point? That would help for giving you advice. What proceedure are you using ( I assume Modified Seldinger), are you using ultrasound? Using straight needle or an IV catheter to get the vein?

If you can give more info, please do. Maybe I or one of the other PICC people can give some specific advice then.

babynurselsa, RN · Dec 29, 2005

When I became neonatal picc certified we attended a class given by a BARD rep. It was a 8 hour clas and you left great manual of resources. THen it was do 3 with an experienced person to oversee. Then you were on your own.

You might just OBSERVE a few that someone else is working on. Ask for tips and secrets.

NO ONE gets every line in.

If you have any specific questions let me know.

BittyBabyGrower, MSN, RN · Dec 30, 2005

Same here....went to a class and then had to have 3 signed off before I could do them on my own, but we aren't allowed to anymore because the attendings want the fellows to do them...even though we were much better!

You just have to be patient...some kids are hard to cannulate....and I used to hate the arm ones...they are a bear to get around the curve sometimes! I had trouble with peeling the sheath away too, but that comes with practice...I still always had some one help me peel it while I held the picc in place. I always had great luck with scalp and saphenous ones.

Good luck...I wish we were still allowed to do them...I loved it!

sparkyRN · Dec 30, 2005

Are you inserting on babies only, or did you get a chance to do quite a few adults first? And how many insertions did you do with a mentor?
Any particular point of insertion that seems to be the failure point? That would help for giving you advice. What proceedure are you using ( I assume Modified Seldinger), are you using ultrasound? Using straight needle or an IV catheter to get the vein?
If you can give more info, please do. Maybe I or one of the other PICC people can give some specific advice then.

We do 2 successfully with a trained nurse then we are on our own. We use the Bard 24G catheter. I work exclusively NICU so, no adults. I am not familiar with 'Modified Seldinger,' and no usg. My 2 attempts on 2 seperate babies were right and left axilla. The first baby weighed about 750gms and the other 600 gms. I think I could do well inserting in the antecubital, but was warned that these are difficult to thread. I did not try antecub on either of these babes because they were both blown. Would there be an advantage for me starting with a little bigger baby and working my way down? I was able to hit the vein, but I found holding the arm in position and stretching the skin taut, but not too tight to be hard.

sparkyRN · Dec 30, 2005

Same here....went to a class and then had to have 3 signed off before I could do them on my own, but we aren't allowed to anymore because the attendings want the fellows to do them...even though we were much better!
You just have to be patient...some kids are hard to cannulate....and I used to hate the arm ones...they are a bear to get around the curve sometimes! I had trouble with peeling the sheath away too, but that comes with practice...I still always had some one help me peel it while I held the picc in place. I always had great luck with scalp and saphenous ones.
Good luck...I wish we were still allowed to do them...I loved it!

Where in the scalp did you stick? I know some nurses like to stick the jugulars, but there is no way I'm going there!

Daytonite, BSN, RN · Dec 30, 2005

When our IV team was trained to insert PICCs we also had to insert 3 as part of our clinical training. We were told it really wasn't enough. You have to do a lot of them. There's too many things that are different in patients. Not everyone has nice, straight, accomodating veins. It takes a number of times doing PICCs to get used to using the equipment and develop a mastery of it--just like any other nursing procedure. How many IV's did you insert before you felt like you were the King of the World at it? Well, the same thing goes for inserting PICC lines. You're being too hard on yourself.

cathys01 · Dec 30, 2005

We have several neonatologists that will not insert PICC lines. None of the night docs do them, so we only have two neonatologists and two NNPs that do them - all of which work days - but lots of days where none of them are there. I wish they would allow the nursing staff to become certified in putting them in - we'd sure save some of our kids (the chronics that get sick) lots of suffering if we could put in a PICC rather than multiple sticks per day for PIVs.

Daytonite, BSN, RN · Dec 30, 2005

We have several neonatologists that will not insert PICC lines. None of the night docs do them, so we only have two neonatologists and two NNPs that do them - all of which work days - but lots of days where none of them are there. I wish they would allow the nursing staff to become certified in putting them in - we'd sure save some of our kids (the chronics that get sick) lots of suffering if we could put in a PICC rather than multiple sticks per day for PIVs.

I can understand your eagerness to want to do PICCs, especially on the off shifts, but our IV Team was a 24 hour service and PICCs were only allowed to be placed during the traditional day shift hours. I felt the same as you since I often worked nights. There, however, are a number of reasons they should not be done during the off shifts. One of which is the obtaining of the consent and informing the patient (or guardian, in your case) of the risks of the procedure. The inserter is also responsible for obtaining the follow-up x-ray to confirm placement of the lines. Although we were taught what to look for in the x-ray and encouraged to look at the x-ray ourselves as well, it was an absolute rule that the PICC line placement had to be confirmed by a radiologist. We always planned on 4 hours for a PICC placement from start to final finish (the OK from the radiologist). This was not 4 hours that was totally spent with the patient, but PICCs often require one, and possibly two, adjustments with follow-up x-rays to confirm position of the line. Until then, that line cannot be used. The middle of the night is not a good time, especially if something goes wrong with the insertion.

BittyBabyGrower, MSN, RN · Dec 30, 2005

You know the big vein that you can sometimes see right in front of the ear? That is the one, but you have to be careful because the artery runs right there too, so make sure you palpate! I never did a jugular....that gave me the creeps! :eek: I also hate to do the dressings on those...they never stick right!

You'll get it...it just take time!!!

babynurselsa, RN · Dec 30, 2005

On an antecubitalyou need the arm straight out and sometimes turning the baby's head away helps it got across rather than down into the axilla.

Sometimes the darn things are just going to go all kinds of places rather than into the svc.

Gompers, BSN, RN · Dec 30, 2005

Wow, I'm so jealous that you all get to start PICCs!!! Of course, even if they offered it to nurses by me, I probably wouldn't go for it - I'm not the best IV stick around, that's for sure. I hit 'em but I can't thread 'em. Art sticks are definitely my stronger point...

They did do a class a few years ago for some of our nurses - when we used the PCVC that had a silicone heart at the end - but then we switched back to the one with the royal blue hub and they haven't given a class for us. So right now, only the NNPs do the lines. That was great when we had a ton of them working 12 hour day and night shifts, because there was always one around who could throw in a line. But now, we only have them on day shift and they're too busy doing rounds on their own babies sometimes to be able to do lines. The fellows should learn, but for some reason they aren't being taught this skill!!! We need a lot more staff members to be certified in this skill, it's really gotten bad lately.