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Difficult PICC insertions

I have a new employee that does two things when having difficulty advancing a PICC line into the SVC.  1) he advances the stylet beyond the end of the catheter and then attempts to advance into the SVC. 2) he takes the guidewire that was used for the initial insertion and places it in the 2nd lumen to make the entire PICC line more ridgid.  We do our insertions at bedside, no fluroscopy. 

Is this common practice?  I have only ever retracted the stylet and placed a floppy end when having difficulty advancing.


NO and NO! First a stylet

NO and NO! First a stylet wire is NEVER intended to be the leading edge into the vein. It is not designed for that purpose. A guidewire is different from a stylet wire. How does he manage this as the stylet wire is always shorter than the catheter? You can retract the stylet wire leaving the catheter tip to float more freely in the blood flow to get it to advance. 

Using the true guidewire to reinsert it back into the 2nd lumen will add stiffness and is done in radiology. This would be an off-label use of the guidewire. Off-label use is possible as long as your facility has policies to direct how such decisions are made for each patient. Check with the PICC manufacturer about what they have to say regarding this practice. As a general rule, any wire advanced into the thorax beyond the upper part of the arm should require fluoroscopy. 

Finally, your state board of nursing may have some type of position on these practices, so check with them as they would be the primary one to establish the boundaries for your legal scope of practice. 


Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

No....not the stylet. A

No....not the stylet. A guidewire is often used that way as long as competency is established. double wire for stiffness?, I've done it, but does'nt always work

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