Use of U/S for PICC line placement

CritterLover, BSN, RN · Jul 17, 2005

i use a portable us for placement of piccs at bedside. i also occasionally use it to place regular ivs as a courtesy to the nurses if they are having trouble getting an iv started but don't have an order for a picc.

in my experience, it works better for picc placement than piv placement, mostly because it is easy to go through the back wall of the vein if you are not paying close attention and going slow. (it is harder to go slow when placing a regular piv because we are not allowed to use lidocaine for piv placement, but can for picc placement; going slow hurts more). while i can often thread the picc past that point in the vein, the piv is pretty much done for if you go through the back wall.

there is a pretty good learning curve with the us, but honestly i pretty much figured it all out on my own. the person who trianed me pointed out the basics; after that, it was just me. i find that i get better at using the us on a weekly basis -- it seems like i'm always figuring out something new, and i've been using it for over a year now, almost 2 years. that being said, when other nurses ask me if piccs are hard to do, i tell them that the two hardest parts are learning to use the us and learning to measure correctly for the different veins. i would love to take a ce course on using the us, though.

something to keep in mind: when you use the us, you no longer have a free hand to palpate and stabelize the vein. this makes it tricky for rolling veins, since you certainly can't stabelize anything with a us probe covered in goo. it is also very difficult to learn to stick while looking up at the us screen rather than down at where you are working.

mommatrauma, RN · Jul 17, 2005

We have a few of our ER docs that did ULS Fellowships...I have been taught to do short IVs(standard periph. IVs) with ULS...we haven't done it often, but it is very effective in preventing a patient from getting a CVP or more invasive type line...one of our new attendings wants us to learn long IV insert. (ie PICCs) we'll see what happens..I've been using the ULS off and on for the last two years..it does take some getting used to...In the beginning we did it with two nurses..one holding the ULS probe and the other doing the sticking...its challenging but it works well for the patients...Although we are using it more often, it isn't yet quite the norm where I work, however I work in the ED...so time definitely plays a factor in the decision to do it...but I think we will see it more and more in the future...

Beenie · Jul 17, 2005

I was wondering how many of you use U/S for PICC line placement or any other type of lines/IVs. Is it becoming more popular? How difficult is it to use? If you are using U/S, are you using portable U/S's?
Thanks!

Quote

PICC placement under U/S in hospitals is becoming the standard for placement It however is not the central line of choice in an emergency TLC in Jugular or subclavian are better in that situation PICC placement is done under strict sterile conditions since thsi catheter can be in place for up to 18 months if no complications . Yes U/S use is at the bedside depending on the product equitment they are battery and current models.

Jean

Bluedevil · Jul 18, 2005

Thanks so much for the great info!

I had another question.

When you place the PICC line, how do you know the tip is in the SVC? Can you tell by feel? Are you always using fluro? Do you first place the tip by feel and then check with fluoro? Or do you skip fluoro all together? How do you decide one way or another?

Thanks!

regnifne · Jul 18, 2005

I was wondering how many of you use U/S for PICC line placement or any other type of lines/IVs. Is it becoming more popular? How difficult is it to use? If you are using U/S, are you using portable U/S's?
Thanks!

I have been using U/S for PICC placement for about 4 months now. I think it is great. I have a 90% access rate up to this point. Most of the ones I missed the radiologist also cannot access. One radiologist now doesn't attempt if I cannot get a vein.

CritterLover, BSN, RN · Jul 30, 2005

when you place the picc line, how do you know the tip is in the svc? can you tell by feel? are you always using fluro? do you first place the tip by feel and then check with fluoro? or do you skip fluoro all together? how do you decide one way or another?
thanks!

we do a pcxr after placement to confirm tip locaiton. we don't use fluro at all (our radiologists do, but we don't work for or with them). we also place our piccs at bedside, so fluro really isn't an option.

Gail-Anne · Aug 5, 2005

Right, U/S is becoming the norm I think. Greater chance of using the basilic vein (rather than cephalic) and getting away from the ACF, so less chance of phlebitis/thrombus. Also, can use the brachial if necessary, could never do that by palpation.

CX-ray post is a must.

If you work as a team, you can have assistant U/S the jugular or listen with a stethoscope on the jugular while you flush. That way you can reposition right away if line went "north". I work alone, so not an option for me. Also, there are "navigators" that can be used to tell where the line went. Last I heard they weren't accepted for use in Canada so don't know much about them. Sounds like they save $$ in the long run re: less repositioning and rex-raying tho.

I had been doing PICCs by palpation for quite awhile, only had a chance to insert 2 with an RN experienced with U/S, definitely suggest doing at least 6-8 with some-one well experienced (depending on your previos insertion experience of course). I think the younger people who have grown up playing video games find it easier to have hands doing one thing while eyes look at something else!

As has already been said- it's quite different not anchoring the vein too at first.

christianRN · Sep 28, 2005

We love our ultrasound. We can now insert a PICC even if we can't see or feel a vein. Must X-ray for placement in the SVC. In many of our large ICU patients with bad lungs, it is difficult for them to see the tip. If kidney function is okay, sometimes we use a couple ccs of IV contrast, and then the tip is easily visualized.