I was consulted to ED to start a 18 g angio in a.c. for a CTPA. I was unsuccessful. A picc was then ordered. I went back & had my sterile field all set up, when angio dept came in & said pt didnt need a picc. It's a long story I wont go into it.  Pt already had a 22 g angio in her other a.c.. Angio dept was going to exchange her 22g for a 18 g with a wire. I assume this would be the same as a picc over the wire exchange. Is this standard practice? Does anyone else do this? Any contraindications to it? Is the 18 g angio catheter strong enough to slide into the skin? I'm wondering if I should have done this instead of a picc? I had offered to place a midline.
Robbin George RN VA-BC
There is one tremendous problem that I see with this practice. The PIV was inserted using clean, no-touch technique. This is not even close to the sterile procedure using maximal barriers for a PICC insertion. So exchanging a PIV for a PICC would increase the risk of BSI, I would think. But I am not aware of any published data on these outcomes.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
What you are describing sounds like use of the Seldinger Technique for the exchange of the 22g.peripheral IV catheter for an 18 g. peripheral IV catheter. Is this correct? (Much like the insertion of Arrow's Rapid Infusion Catheter using a pre-existing perip. IV site.) If so, the one doing the insertion usually nicks the skin with a scalpel @ the site and/ or uses a dilator. So, the strength of the 18 g. catheter is not an issue.