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Exchanging 22g PIV for 18 g angio
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
We have used Ultasound many
We have used Ultasound many times to insert a 20g IV catheter (They do NOT need an 18g even for CT) in a shallow AC vein to facillitate treatment of patients in the ED--We usually draw blood at the same time--If the patient is admitted and if it is necessary we will insert a PICC  

Robbin George RN VA-BC

There is one tremendous

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

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

What you are describing

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. 


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