Hello,
I see nurses using radiology wires to insert piccs at the bedside without fluoroscopy to guide them. Am I crazy, or is this unsafe practice? I'm curious to know everyone else's opinion on this. Your thoughts?
Eileen Martin
Hello,
I see nurses using radiology wires to insert piccs at the bedside without fluoroscopy to guide them. Am I crazy, or is this unsafe practice? I'm curious to know everyone else's opinion on this. Your thoughts?
Eileen Martin
Our state practice does not support this. I also don't think that this is safe for all patients without fluoro.
Gwen Irwin
Austin, Texas
You are not crazy and this is an unsafe practice. For a bedside procedure, a guidewire used to purchase the vein should never be advanced passed the shoulder. The 80 cm wire might work ok but definitely not much longer than that. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I wonder why the nurses are choosing to use such a long wire at the bedside?? Is it the only one available? (some facilities will only purchase radiology kits if they are less expensive), Is it fear of losing the wire? How far are they threading the wire into the vein? Often there is a safer alternative to reach the same result.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
This is not wise practice. Lynn is correct that wires should not be advanced past the shoulder at bedside. Without fluroscopy you cannot see where it is going, so it is not advantageous or safe. Also, there is the risk of wire contamination with a long wire, particularly if one is working alone. Getting to the end of the wire to put the introducer on the wire can be difficult.
are they using them as guidewires or as a stiffener inside the catheter, but not protruding from the catheter?
I have watched them attempt to advance the catheter, and if it will not advance within the thoracic cavity for whatever reason (scar tissue obstruction, clot, aberrant anatomy, etc.), they advance the stiff guidewire as a physician would under fluoroscopy to aggressively force their way toward their destination, the SVC...unfortunately, without the advantage of image guidance or the ability to inject dye if necessary to visualize the patients anatomy, they are placing the patient at great risk and compromising their safety. I truly feel that new clinicians are being trained to perform this procedure with this fluoroscopy guidewire without really realizing the risks they are taking.
I agree this is extremely dangerous and it sounds like some lawsuits in the making. I also agree that it is due to lack of proper education about these risks. Have your tried to bring this to their attention? Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I am embroiled in a hornets nest over this issue. I have brought this out into the open, but I have become EXTREMELY unpopular because of it. My willingness to speak out and be heard regarding this safety issue is biting me on the bottom, I'm afraid.
Sorry to hear that but just hang on to the fact that you are acting as a patient advocate, which is what all nurses should be doing. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I was trained with the long RAD wire by a very skilled vascular access specialist, she stressed never to pass the shoulder. Once the wire is at the shoulder you pull the rest of the wire out of the plastic and hold the end never letting it go to get contaminated once the peal away (dialator) is threaded over the wire its bent over so that it will not slip (in or out) and the tip of the exposed wire is put through gauze to weigh it down and maintain control.
I have seen lots of PICCs placed by many different people, some that are text book and not safe. Others that do things a little different and are very safe and good at what they do. I think its hard to really say someone is unsafe unless you saw it your self. And I bet those people that are unsafe would be no matter what tools they are given.
Some people are willing to take more risks than others, unfortunately in this case, their willingness to practice in an unsafe manner is risking the safety and well-being of another human being.
I understand what you mean regarding the threading of the dilator over the extended wire...that is different from what I have referred to here. What I have witnessed was the use of a short wire FIRST to establish the access to the vessel via the introducer needle, then SECOND to place the dilator and sheath within the vessel. The short wire is then removed. The catheter WITHOUT a stylet is then advanced into the vein. The lengthy guidewire is partially inserted into the catheter to give it the stability it needs to make it through the valves within the upper arm, then I witnessed it as they manuvered the guidewire beyond the shoulder in the attempt to advance the catheter BLINDLY....THIS is the part I am referring to as unsafe. I fear others less experienced may be trained in this technique by the risk-takers and not really understand the potential consequences are of what they are doing. This aggressive approach, which is perfectly acceptable when performed by a physician under image guidance, is NOT acceptable by a nurse at the bedside. I am sure there are many clinicians such as you that use a radiology kit appropriately at the bedside, and I applaud you for your adherence to safe practice...your knowledgeable capabilities are not my concern. I am simply voicing my concern over the clinicians who may not be as skilled as yourself that can potentially cause great harm to an unsuspecting patient. Can we agree there are different levels of expertise, critical thinking skills, and concern for patient welfare among clinicians? That is all I'm saying...
Does anyone know if it's acceptable for an RN using fluoro to place a long wire centrally and put the PICC line down over it? With a tech of course! I have contacted my board of nursing but got the vague answer we usually get. Thanks for any thoughts!
Andrea Miller, RN, BSN
Akron General Medical Center
Akron, OH
To use a wire longer than 80 cm without the use of fluoroscopy is asking for trouble. We occasionally use a 65cm wire but are careful NOT to extend beyond the lenth of the catheter itself.