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Cheryl Fry
PICC insertion in patients with loose skin

What do you do when needing to place a PICC in a patient with loose, flabby skin? Any tips? I have come across people who have huge veins on ultrasound, But I can't enter the vein-the needle bounces off. What do you do?

thank you, Cheryl Fry CRNI


Karen Day
Karen Day's picture
when you position your

when you position your patient's arm for placement,  place a couple of rolled up washcloths under their upper arm where you will be inserting the picc, this helps support the flabby arm and provide easier access to the vessel. 

It's a little tricky at

It's a little tricky at first, but with my ultrasound hand, I will grip the probe with my thumb and first finger, and use the side of my hand and other three fingers to pull the skin taut while I access the vein. And because that skin is so loose, I'll do the same while advancing the PICC. Works for me very easy every time.


Mike Allen, RN

mary ann ferrannini
..I set the arm up before I

..I set the arm up before I place the PICC...I prop the towel carefully.....this is wierd but I have been doing it for yrs on PIVS....... I get a long piece of  transpore tape (the tape must be stretchy)  then I place above the site on the skin and pull on the skin  and then tape the opposite end to something stable,usually the bed frame. It has to be placed carefully so it will be under the drap of course. Then when the torniquet is tied...pulll all the excess (if any) up and under the tourniquet.many moons ago I got really tired of waiting for a nurse to help me with traction  so iI devised my own liitle traction/loose skin control method. it does look a little strange BUT I always get the vein...Play around with it on PIVs and you will see it works

Mats Stromberg
Picture of that?

I'd love to see a pictorial of that.


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