I have had several occasions when my Picc wire has gotten stuck in my stylet and I could not retract my wire. The only way to get the wire out was to also remove the stylet. When the stylet and wire are removed the wire is all cured up. Any thoughts on how and why the wire gets curled and stuck. Any thoughts on how to foresee or to prevent this from happening.
Nitinol wire with a floppy tip?
Advance wire carefully and slowly. If you have ANY resistance, or concerns, pull wire back and check. With the stiff wire and soft end, any amount of force will cause wire to curl if you're not right in the vein.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
By PICC wire, I am assuming that you are referring to the guidewire used to purchase the vein. By stylet are you referring to the finder needle used to make the venipuncture for the MST procedure? If so, my guess would be that the guidewire is curling because 1) you are not inside the vein lumen, 2) the veins are obstructed with scarring or sclerosing or plague. Are you using US to assess the vein?
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
Just to make sure I understand you:
1. There is a needle to stab the vein
2. There is a guide wire to advance through the needle into the vein. It is preffered to use a guide wire with a Nitinol floppy tip That guide wire will not advance smoothly in the vein if the bevel of the needle is not completely in the center of the vein or if the vein has abnormalities like a thrombus, sclerosis, stenosis, etc, but if you use your Ultrasound both for a longitudinal view and cross view, it should give you some clues as to the condition of the vein. If your bevel/needle is between the vein layers it will cause the guide wire to get "stuck", and attempting to pull it out of the needle will be difficult, causing the tip of the guide wire to either "fall apart" or get curls when it gets stuck on the tip of the needle or in between the vein layers. In those cases, you should abort your attempt and try again to stab the vein in a different site.
3. The Stylet is the wire that goes inside the catheter itself to make it "stiffer" and allows you to advance it into the SVC. If you are unable to pull the stylet out of the catheter (after you positioned it in the SVC) it is most likely because of severe venospasm, or somehow you were able to advance the catheter into a collateral vein. When the difficulties is in removing the stylet out of the catheter, it is rare, usually indicating of difficulties downstream from the point of insertion. If it happens, what you can do is slowly pull out the catheter while attempting to pull the stylet out out of the catheter at the same time until it "gives", wait a few minutes and attempt to advance the catheter again.
4. Then there is the "problem" of after you complete the advancement of the catheter and when you pull the stylet out, you can see a bend or curl on the last few cm of its tip. This will almost always indicate that the catheter tip is not in the right place.
I hope this does not sound too confusing. Just make sure you know which is the guide wire, which is the stylet. The wire cannot be in the stylet, the way you asked your question.
Rivka Livni PICC RN
Kathy Kokotis
Bard Access Systems
You referred to a wire and a stylet. Are both in the catheter at the same time. In other words are you practicing "stiff wiring". If that is the case not only is that practice dangerous it is not in accordance with the guidelines for use of any PICC line I know of. It would not surprise me if the stylet or wire curls, breaks off, or becomes stuck. If it is "Stiff wiring" it is very common for all of the mentioned complications to occur. Stiff wiring at the bedside is not safe nor recommended. There is no fluoro It is an off label practice that seems to be occurring.
Kathy Kokotis
Bard Access Systems
Nancy S.
This video of U/S guided CVAD placement has a section that is an excellent example of how a floppy tipped introducer guidewire behaves - even when it appears to be passing through the center of the vein and is meeting minimal resistance, it flops over.
Now imagine what this guidewire does if the introducer needle has cannulated the vessel off to the side, or you have over or under-reached?
Good argument for visualizing cannulation with transverse AND sagittal views.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Michell
I cannot visualize your method of accessing the vein. Can you describe it step by step from the beginning to the point that the wire curled up?