Is there an easier way to place a picc line in a spastic or contracted patients. I get the introducer in start putting the picc in and it will not advance. Any suggestions?
Are you using ultrasound and making the venipuncture in the mid-upper arm? I do not see any possible way to make a venipuncture in the ACF area in a patient whose arm is contracted at the elbow.
When you start advancing the catheter, the US will tell you that you are inside the vein lumen. You could be dealing with contracting skeletal muscles and a drug such as midazolam would help. Or you could be dealing with spasm of the smooth muscle inside the vein and you will need other drugs that work on smooth muscles.
But you have to think about the care of the patient and the catheter after you get it inserted. Is the site in a contracted area where dressing integrity and changes will be very difficult. For this and other reasons a PICC may not be the best choice for these patients.
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
Yes I'm using an Ultrasound.. And yes it's the mid upper arm area. I'm thinking it has to do with the anatomy. But not sure how to work around it.
In contracted patients I prefer the axillary or IJ. I have used cephalic veins, but I am concerned with lack of movement and increased risk of thrombosis.
Judy, I am certain you are talking about insertion sites in either the IJ or axillary vein. And the axillary vein is punctured in the infraclavicular area, the area commonly known as subclavian site. But a puncture site directly into the subclavian vein is far too medial and would most likely lead to pinch-off syndrome. So a more lateral puncture site would be in the axillary vein and prevent pinch-off syndrome. For patients with arm spasticity, it would seem that these would be the best insertions sites. Lynn