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Bernadette Luca...
I would like information on what other hospitals are doing when there are numerous unsuccessful PIV attempts made on a patient for a CT with IV contrast and then a physician writes for PICC placement just for the scan and then to be removed. This seems like such a misuse of PICC lines and an unjustice to the patients vasculature but in discussing with the M.D. there is "No other Option". Would love some feedback on either policies or procedures that I could use as resources or just any solid information.
Most are using ultrasound to

Most are using ultrasound to place a peripheral catheter for CT instead of placing a PICC when the CT contrast agent is the only infusion therapy needed. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

I can usu justify because if
I can usu justify because if the CT comes back positive for whatever they're loking for, the patient will need access anyway.
What size peripheral
What size peripheral catheter are you using to insert with ultrasound and what length is that catheter

 Darla Tarvin RN VA-BC

Mercy Clermont Hospital

Bernadette Luca...
Karen,  I was wondering if


I was wondering if you are referring to PICC or PIV using ultrasound? If it is a PICC I understand your point but how often do you think the test is positive and the patient keeps the access?

We have been faced with

We have been faced with these same issues.  We started placing PIV using a longer IV catheter - but it seemed that they would still  infiltrate easily.  We finally decided to only place ultrasound guided PIV's in superficial veins such as the cephallic.  We were very concerned over contrast infiltrations(vesicant) in deep veins and their close proximity to nerves.

Bernadette Luca...
Can someone direct me how

Can someone direct me how they obtained competency in placing USN guided PIV?? What were the steps to get this started for your team as we are interested in this at our hospital

Timothy L. Creamer
  Commonly used iodinated


Commonly used iodinated contrast agents
Compound  ↓Name  ↓Type  ↓Iodine Content  ↓Osmolality  ↓Level  ↓
IonicDiatrizoate (Hypaque 50)Ionic Monomer3001550High Osmolar
IonicMetrizoate (Isopaque Coronar 370)Ionic3702100High Osmolar
IonicIoxaglate (Hexabrix)Ionic dimer320580Low Osmolar
Non-IonicIopamidol (Isovue 370)Non-ionic monomer370796Low Osmolar
Non-IonicIohexol (Omnipaque 350)Non-ionic350884Low Osmolar
Non-IonicIoxilan (Oxilan)Non-ionicLow Osmolar
Non-IonicIopromideNon-ionicLow Osmolar
Non-IonicIodixanol (Visipaque 320)Non-ionic dimer320290Iso Osmolar

 The decision of PICC versus PIV for CT contrast injection must be individualized to each patient correlating comorbidities, history, and present peripheral vascular presentation. A risk versus benefit approach for each individual. Contrast agents with an osmolarity rate >600 fall within INS standards of central vein delivery. Contrast extravasation can be devastating, even a low osmolar nonionic agent infiltration has potential serious damage depending on PIV location and amount of contrast. Remember the contrast is power injected, warmed but viscous infusate at about 5ml/sec. First do no harm.

Hope this helps.

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Florida Division

Timothy L. Creamer RN, CRNI

Clinical Specialist, Bard Access Systems

Florida Division

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