I have been placing PICCs with US & MST for years, prior to the arrival of the reverse taper catheters on the scene. Â I would love some feedback from the rest of you regarding the following areas. Â Does anyone insert the catheter all the way to the hub, having the hub push up into the site to use as pressure to stop the bleeding, or do you leave the approximately 1cm that is distal to the "0" hash mark outside? Â Does anyone know if the catheter continues to taper larger beyond the "0" mark? Â Are there any studies regarding increased thrombus formation when the catheter is shoved all the way up to the hub?In some people this may be less significant, i.e. if the patient is heavier, therefore vein is deeper, so fatter part of catheter and hub don't push into the vessel. Â But what about the patient who is very thin with superficial vessels and very thin friable skin? Â I have seen the hub shoved clear into the skin, and in some cases this pressure can erode the venipuncture & skin nick site into a large "hole". Â Â I have had one very experienced nurse tell me she was taught to do this to prevent bleeding. Â My goal used to be to have the "0" mark right at skin level. Â Lately, I have been leaving 1-2cm external so I don't have the fattest part of the taper in the vessel, especially if the vessel is on the smaller size, where the catheter diameter is going to take up more than 1/3 of the vessel diameter. Â Most of the facilities I go to use the Poly PerQCaths and the Bard PowerPICCs. Â Some places use the Jet Medical lines. Â Where does it tell you at what cm mark the reverse taper starts on these catheters? Â I have not have trouble with bleeding. Â If the site is bleeding, I have found I can push the catheter in to act as a tamponadeÂ while I have cleaning up, skinprepping the site, etc, and by the time I am ready to secure it with a STATLOK, the bleeding has usually slowed significantly and I pull back to leave my 1-2cm external. Â What are the rest of you doing in terms of amount of catheter left external? Â I used to put it in further, but over the years with the larger catheter and the reverse tapers, I have become more concerned about having the larger diameter in the vessel.. Feedback appreciated.
Halle Utter, RN, BSN
Intravenous Care, INCÂ