I have been having trouble with inserting picc line catheters that are greater than 40cm in length. We use the Bard power picc and it comes with a very flimsy guide wire thats about the thickness of a hair. It helps to also use the 36cm guide wire as extra rigidity, however, I find at anything past 40cm will almost always give me trouble going up the neck or curling in the subclavian for example. Any advice on this topic would be greatly appreciated!
The stylet wire inside the PICC is designed to be soft and flexible for a reason - preventing vein damage. I strongly advise AGAINST inserting a stiffer wire into that catheter for insertion. ALWAYS follow the manufacturer instructions contained in the booklet in each package. A few things you should try is patient positioning with the arm at a 90 degree angle and the patient with their chin on their chest on the same side as insertion. Then slow down the speed used to advance the catheter. Allow it to follow the bloodstream so slow is better. Never advance rapidly or forcefully. There will always be a few patients with a primary malposition on insertion and you have to manage those immediately but the extra wire is not the best way.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Right. Thanks for the quick response. Ill follow the guidelines better as far as not using the extra stylet. About the advancing slow technique, I discovered that on my own actually and so Im glad to hear it reinforced here, and do that everytime. I can almost feel the bloodflow caused by the heart pumping and can feel naturally when the line is going smooth into the right place. Your other textbook type examples, like angle of the arm and turning head towards the line I also already do on everybody.
My problem is more when the line is longer, like 44cm or longer for example—I find the longer the catheter, the more flimsy, unpredictable, and more troublesome it is to work with. Any other tips or tricks anyone know of when working with longer lines? Or does anyone else even struggle with this problem like me?
thank you
Andrew Edwards, RN
We use the Bard power picc as well.
Most of our lenghts are longer than you are referencing and we do not experience that situation. We have been doing PICCs for approx 17 years.
When we do have trouble advancing it is usually an individual occurence not a trend as you mentioned. We utilize the above mentioned measures in Lynns post to assist with re positioing, some times using a slight twisting motion of turning /twisting PICC line to the right ( clockwise) as we are slowly inserting.
When you are cutting the catheter are you being sure to fully advance the stylet then retract it once fully encased in the PICC line? Might you be pulling the stylet up too far where it is not present in the catheter below that mentioned 40 cm??
Gina Ward R.N., VA-BC