2 questions as a result of orienting new PICC RN.Â Even though we have tip location, this nurse insists on using "jugular pressure" whereby she uses the ultrasound probe to push into the jugular vien above the clavicle to prevent tip going into jugular.Â Sometimes the pressure causes discomfort and I also wonder about massaging the carotid while doing this. What say you? I would like to have some expert opinion to convince.
Also, sheÂ sometimes places PICCs very high, as far as an inch or two below the axilla (so thereby accessing the axillary vein inÂ some cases). Although she states this is not her usual practise, I have seen it frequently and the reasons are usually, too small of veins or multiple bifurcations. What can I say to discourage this? How high is too high.Â My thoughts are that the axillary vien is not considered to be a vein for access for piccs and also increased chance of infection.
Â Thanks for your opinions
Scripps Green Hospital