We are a very experienced, small IV Team that places approx. 80 PIOC's /month...In the last year we have had too many patients that we have had to send to IR to have microintroducer wire removed...seems the wire "curls" or loops on itself... it is easily removed by IR, but a hassle cause we have to call them in and of course, they aren't happy about that...I talked with our rep and their nurse expert who gave us some suggestions but really couldn't see anything we were doing wrong....I think we are going to have to include this as a possible risk on our consent form if we keep this up....Does anyone have any suggestions on how we can avoid this?
Are you saying the wire (microintroducer) you are putting in your needle to access the vein then put the introducer over is getting stuck? This would mean you couldnt even put your pick line in the intoducer I havent had that happen. I would think maybe when the wire is first being introduced it might be being inserted with more pressure or against resistance and it is coiling. What kind of wire is it? I know different companies have made changes with wires to decrease it kinkinig or holding the bend in it if it goes against the wall or something. If it is this microintroducer wire, are they manipulating the wire within the needle. ?
Or are you saying your stylet in the picc line cant be removed?
I think we need more info. thanks, Gina
Gina Ward R.N., VA-BC
I hesitate to respond to an experienced team, but when I read this, I automatically think that the "wire curls" occur when you are not fully in the vein. If the needle has not penetrated the vein wall completely, blood return can be great and make you think it is there. But, because part of the needle bevel is in the vein (the bevel is longer and wider than the wire), the wire doesn't advance without curling or looping. The slightest resistance met with the wire could be an indication that the needle tip is not completely in the vein.
If that is the case, I would pick up the probe and look as I advance the needle slightly. Try to see that the needle tip is in the middle of the vein and attempt to advance again.
In our years of ultrasound use, this has worked to prevent curling or looping of the wire. If it is in the middle of the vein, the wire meets no resistance and easily advances. I am sure you know what that feels like to have the wire flow in so easily. Anything else felt could indicate not really being in the middle of the vein.
I thought of one more thing. I have turned the needle 180 degrees, while in the vein and tried again with some success.
Hope this helps.
Gwen Irwin
Austin, Texas