I have placed more than 150 PICCs. Yesterday, I tried to access a basilic and a brachial vein. Both veins were medium-large lovely black holes on the ultrasound screen. Each vein was 1cm deep and I used a 1cm needle guide. I could see the needle in the middle of the vein. No blood. I tried both veins twice with the same result. The patient was tense and very willing. Venous spasm? Can anyone tell me what was happened?
Thank you,
Nancy
Were you able to thread the wire? I have seen this a few times where the patient was hypotensive. The needle was visible in the vein on the ultrasound but I did not get a flash back. I gently threaded the wire and it threaded easily. I went a head and threaded the PICC and then received a blood return. I've placed over a thousand PICCs and I've only seen this a few times. Hope this helps!
Thanks, Vickey. I didn't even try to thread the wire, but I thought of it later and wished I had tried. If this ever happens again, I will try passing the wire.
Also, I used a tourniquet which may not have helped the situation. Seems others are not using tourniquets, displaces the vein, creates venous spasm, makes the vein less relaxed resulting in a more difficult cannulation (all tips from this website.)
Nancy Rose
You might be right about the venospasms. What might have happened is while the vein is in a spasm, the blood gets diverted to the collaterals. I've seen this happen several times and yes try passing the wire next time.
Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]
Did the veins compress well? "Wink" at you? Veins with clots show up great but they don't compress and wink at you like a healthy vein does.
Hallene E Utter, RN, BSN Intravenous Care, INC
I have had a few situations in the years of inserting PICCs that I knew that I was in the center of the vein, based on the ultrasound image. I had no blood return at all. I was easily able to insert and advance the wire. No blood return with the dilator/sheath, but the catheter easily advanced. I can't recall that the patient was hypotensive or anxious. I just relied on the image of being in the middle of the vein (ultrasound) and that there was no resistance with the advancement of anything. I had an experienced nurse observing and she coukldn't believe that there was no blood return.
So, my suggestion is that if you see the needle iin the middle of the vein, thread the wire and proceed.
Gwen Irwin
Austin, Texas