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patricia fahy
MST with Ultrasound
At my organization we have been using U/S guided, MST, PICC placement for about a year. We have been very successful. However, I sometimes have to stick a person twice because I can not thread the guide wire after cannulating the vien. I try not to change the pressure on the U/S probe, I drop my angle slightly. I would appriciate any advice on how I might improve  my technique on this part of the PICC insertion. Thank you, Trish
Robbin George
Except with very deep veins
Except with very deep veins I use an IV Catheter to capture the vein--A 2" 20g works well for most situations 

Robbin George RN VA-BC

Here are some

Here are some suggestions:

1)  Verify that indeed your needle did go thru the entire top vessel wall. Sometimes the vessel layer separate and the needle looks like it is in the center of the vein, but  it actually is hung in inbetween vessel layers.

2)  An option that IS NOT ideal, but that may be necessary is a thru and thru and thru technique, which means that you obseve your needle go thru the top and bottom walls of the vein.  YOu can then "see" the needle come back into the vein and also "feel"  with you fingers.  There is a slight release on the needle, which is pretty cool to feel.

3)  Once the vein is entered and two things occur--I see the needle in the middle of the vein and I "feel" is pop thru the vein wall, I make sure that I DO NOT move the needle even a hair.  I use the ultrasound to stabilize the needle in the perfect place and using my left hand pick the wire up (that is out of the coil and near my right hand) and gently thread it into the needle all the while keeping the needle in the exact spot where I successfully cannulated the vein.  Most of the time the wire will make the curve out the end of the needle into the vein, but if not, I just gently lift up on the transducer and gently push the wire out.

Hope this helps and forgive the typing mistakes.

Cheryl Kelley RN BSN, VA-BC

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