Using a site rite ultrasound. HELP

[HyperRNRachel]

I've won the nursing lottery! After being burned to a crisp as a 7p-7a ER nurse for the last 4 years, I was offered an incredible day position in the cath lab working 8 hour shifts 5 days a week. The position is awesome! The hospital is awesome! It's a small hosital with a one room cath lab. Since there can be "down time" I am also being trained on PICC line insertion and LOVE IT. The set up is time consuming, but I'm comfortable in that area but I'm having one small problem- (haha only the most important part). I'm having a difficult time keeping my vein centered while attempting to access. Any advice, pointers, suggestions, thoughts or help is much needed. Are there any training aids, books, or classes that I should be looking into?

Thanks

Rachel

[BethGCRNI]

When I first started placing PICC's I had the same trouble. I had to learn to use my non dominant hand to situate the probe and my dominant hand to stick. It took several insertions to get the feel of it. Good luck to you. The more insertions you perform the easier it becomes.

[iluvivt, BSN, RN]

Yes it is more difficult than it looks and takes quite a bit of practice and hand-eye coordination. Here are a couple of things that I teach new PICC insertors.

1. Hold the probe at the base of it so your non-dominant hand is against the pts skin. That way your hand is against a surface and does not move as as much. You will then just have to move it from side to side to relocate the vein once you have applied the sterile probe cover . Just prior to venipuncture check your hand position. Hold the probe flat to the skin

2 What really helps me is to have the pts arm as flat as possible so you are not sliding around. I tend to need the HOB down as much as possible and prop the arm under clean towels. I get the patient in the position I need prior to draping..then once sterile I can make slight adjustments.

3 Use your dot markers..that will help you so much.....lining up from the start saves you a whole lot of grief during the insertion. Are you using a needle guide b/c the advice I would give will be a bit different.

4 Get your target vein in the center of the US screen...so use your depth markers...this is where the vein can be seen the best

5. Make your venipuncture fairly close to the middle notch on the probe cover so you will be able to see the needle..advance the needle slowly...scan up to see the tip if needed..not side to side...look for the needle tip as it approaches the target vessel..look for the vein indent...I do not not always see this..but I usually can see the needle tip...I think you know the rest. practice holding the probe cover and needle study while you look up at the screen. Advice your pt to hold very still during this part..a moving pt makes this very difficult

[cxbf]

If you ever golfed, it is like lining up your tee shot. No kidding. If you line yourself up correctly and go right at it, you are dead center 99% of the time. : )

[iluvivt, BSN, RN]

Luckily I was always good at putting..a miniature golf pro:up:. so yes it is quite like hitting a target but once the needle has punctured the skin you can make adjustments as needed ..