Hello guys! Im a very new vascular nurse and I have a questions about the rate of your failed PICC attempts in your hospital. I had multiple failed PICC attempt due this week and its very discouraging.
3 cases where wire is not advancing smoothly even thought im very sure that im in the vein, no bifurcations detected upon assessment in the ultrasound(i always go horizontally and follow the vein). cath;vein ration is about 30% or less but resistance is somewhat felt around the subclavian area when i insert the wire. I am very discourage and it is giving me fear and doubt about my abilities ive been working for 2 months by myself now and never had problems with other patient before. Ive inserted about about 80 piccs by myself without difficulty. I usually use provena 5FR/DL PICC.
1 case where pt has both contracted arms, inserting wire is having resistance but when i repositioned the arm wire is going throught, however, when I attempted to insert the picc, even repositioning is not allowing me to thread it so I ended up changing the picc to midline. Did not attempt to do it on the other arm and just refer it to IR right away.
1 case where patient possibly have an SVC syndrome according to my preceptor. upon checking CXR picc coiled around brachiocephalic vein ended up changing to midline.
I want to get some information/tips and tricks from you guys how you handle this situation. I already tried troubleshooting in many ways my preceptor told me that can help with difficult insertion but somehow it still failed. now I have to inform the doctor and refer the things to IR. very sad week for me.