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Free hand needle insertion vs. using needle guide

We are a realatively new Picc team (9 months).

Recently, our Interventional Radiologist suggested we learn "free hand" USG needle insertion in addition to our needle guide attached to our probe.  IR uses "free hand" and says that our success rate would increase if we learned to not rely on the needle guide attachment.  IR feels we would access those deep vessels >3.5cm which is our deepest depth on our needle guide kits.  We have a SiteRite 6. 

Can anyone give tips on this skill.  Naturally we are nervous and would like to hear from Picc Nurses.


Lois Rajcan, BSN, RN

IV/Picc team

Chester County Hospital

West Chester, PA

rivka livni
Since you already have 9

Since you already have 9 month experience inserting PICC using U/S guide, it should take you no time at all to change to free hand held needle.

Just hold the probe w/ your non dominant arm, hold the needle with your dominant arm, angle it at almost perpendicular to the skin surface about 1 cm away from the probe, stab the skin and watch for the needle "appearing" on your screen inserting it until you see the needle "dimple" the vein, manipulate the needle so it enters the vein as much at the center as possible.  The rest will happen.... It just takes practice, practice, practice.

Using a free hand technique our referal rate to IR because of inability to get the vein is ZERO.

We refer to IR known venous occlusions, known stenosis of central veins, we have a list of IR insertion only patients who are known to have central venous problems and those we can not complete the bedside insertions (we send them to IR with the partially inserted catheter, so IR can do a limited venogram and they can use our partially inserted catheter to do an over the wire exchange).

Our overall referal rate to IR is about 3%

I am not sure what the national IR referal rate is, but I would guess it to be around 5% to 10% so if you refer to IR only 5% of patients, you are doing fine.

Gwen Irwin
We have about half and half

We have about half and half using needle guide and free hand.  In my opinion, it is hard to teach the free hand technique.  The nurses that don't use the needle guide have more experience using ultrasound and understand where the needle is, therefore are comfortable without a needle guide.  But it is very to teach!  We also have radiologists that insist that it is easier.  I learned without the guide, but had so many problems in teaching it.

Not sure that this helps.

Gwen Irwin

Austin, Texas

free hand is a learned

free hand is a learned skill, just like using the needle guide.  i never learned to use the needle guide.  i have a problem even teach another how to use it.  i agree with other's advice in learning the free hand.  sometimes veins move and you have to chase them.


I have always used needle
I have always used needle guide method, and I don't know that I ever have a vein that I see but can't stick.  I went into another hospital this past week to teach.  They had no needle guides and to me it seems that you are fishing more that way.  I feel with the needle guide you are directed to the vein, also with a site rite, it allows you to follow the dots in the center of your screen.  If you need to go deeper, get some guides that are 20g and use your pink neddle that you thread like a catheter.  I suppose what you are use to is what works best for you personally.   After I saw working with out the guide I wondered why any one would do that if giving the choice to use it.  Just my opinion, I found it very difiicult without.  Susan
I found the needle guide too
I found the needle guide too using freehand,you can tip your needle to capture the vessel even id the venipuncture is off it's need for additional sticks in most is easy to your skills
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