has anyone heard of the practice of using the guidewire and the wire already inside the picc togetheras a way of making the picc stiffer thus getting it to go where u want it? it dosen"t seem safe to me
Any manufacturer that i have asked about this practice has been adamantly against it. Why would you want to be that aggressive? Vessel health and preservation is the key. Usually soft is better for passing difficult veins.
Lauren Blough, RN, BS, CRNI, VA-BC
Clinical Development Manager
Biolife, LLC "Makers of StatSeal"
The first thing that comes to my mind is what is actually causing the obstruction. Are you doing this blindly at the bedside or under fluoroscopy? If blindly at the bedside, you have no idea what is causing the obstruction and what damage you made do by stiffening the catheter so that it can be forced through this obstruction. What happens if you force the catheter through the vein wall and cause a massive bleed? What happens if you force the catheter through a stenosed area and cause severe damage leaving the patient with venous insufficiency and extremity edema? There could be a lawsuit. Since no manufacturer supports this practice with their product, you and your facility would be left to face this legal challenge alone. I do not believe this do be a safe practice. Recannulation of stenosed vessels may be possible however this should be in the hands of skillful people with fluoroscopy or some other means of visualizing the obstruction. Lynn
Sometimes it is just the vein and skin do not allow the PICC to advance at the insertion site. Especially on the elderly. I call it floppy vein syndrome. In my opinion it happens at the insertion site rather than in the chest. I have place at least 2000 PICCs since 2008.
So it sounds like the skin rather than any type of venous obstruction is actually the problem. If that is the case, you can usually manage this by skin traction with your nondominate hand. Pulling the skin taut should reduce the resistance while you are advancing the catheter through the puncture site. What about the skin nick to enlarge the puncture site? Are you certain that this is large enough to accommodate the catheter. The finder needle is usually small and the catheter going through it is much larger. That could be causing some of this resistance. I have seen the time when skin traction works to advance the catheter in patients with very loose skin. This could be applied from below the insertion site over the drape. Or you might need an assistant to reach under the drape from above and stretch the skin toward the shoulder. Of course this person would need to be vigilant about not compromising the prep area. I am sure others may have suggestions also. Lynn
We have used stylet wire and guidewire for stiffening the tip. This prevents coiling within lumen. NEVER force a line even with the added stiffening technique, especially blind. If an .018 wire get resistance.. you have a stenosis or DVT. Stop..call IR or get an IJ central line placed.
I have to agree with Lynn that most commonly the use of stiff wiring is with the skin and subq tissue. After trying to retract the skin when the introducer is removed and we are unsuccessful with advancement, using the other wire in a very short area (<15 cm), we are then successful in continuing to advance the catheter. I have seen this occur most often with the elderly that have very loose skin and poor skin turgor.
I agree that aggressive use of this technique in the advancement blind is unacceptable.
Yes...this practice is being found widespread in the picc community...VERY unsafe practice.
Any manufacturer that i have asked about this practice has been adamantly against it. Why would you want to be that aggressive? Vessel health and preservation is the key. Usually soft is better for passing difficult veins.
Lauren Blough, RN, BS, CRNI, VA-BC
Clinical Development Manager
Biolife, LLC "Makers of StatSeal"
The first thing that comes to my mind is what is actually causing the obstruction. Are you doing this blindly at the bedside or under fluoroscopy? If blindly at the bedside, you have no idea what is causing the obstruction and what damage you made do by stiffening the catheter so that it can be forced through this obstruction. What happens if you force the catheter through the vein wall and cause a massive bleed? What happens if you force the catheter through a stenosed area and cause severe damage leaving the patient with venous insufficiency and extremity edema? There could be a lawsuit. Since no manufacturer supports this practice with their product, you and your facility would be left to face this legal challenge alone. I do not believe this do be a safe practice. Recannulation of stenosed vessels may be possible however this should be in the hands of skillful people with fluoroscopy or some other means of visualizing the obstruction. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Sometimes it is just the vein and skin do not allow the PICC to advance at the insertion site. Especially on the elderly. I call it floppy vein syndrome. In my opinion it happens at the insertion site rather than in the chest. I have place at least 2000 PICCs since 2008.
Lynn Davis-Deutsch
Seton Family of Hospitals
Vascular Access
So it sounds like the skin rather than any type of venous obstruction is actually the problem. If that is the case, you can usually manage this by skin traction with your nondominate hand. Pulling the skin taut should reduce the resistance while you are advancing the catheter through the puncture site. What about the skin nick to enlarge the puncture site? Are you certain that this is large enough to accommodate the catheter. The finder needle is usually small and the catheter going through it is much larger. That could be causing some of this resistance. I have seen the time when skin traction works to advance the catheter in patients with very loose skin. This could be applied from below the insertion site over the drape. Or you might need an assistant to reach under the drape from above and stretch the skin toward the shoulder. Of course this person would need to be vigilant about not compromising the prep area. I am sure others may have suggestions also. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
We have used stylet wire and guidewire for stiffening the tip. This prevents coiling within lumen. NEVER force a line even with the added stiffening technique, especially blind. If an .018 wire get resistance.. you have a stenosis or DVT. Stop..call IR or get an IJ central line placed.
I have to agree with Lynn that most commonly the use of stiff wiring is with the skin and subq tissue. After trying to retract the skin when the introducer is removed and we are unsuccessful with advancement, using the other wire in a very short area (<15 cm), we are then successful in continuing to advance the catheter. I have seen this occur most often with the elderly that have very loose skin and poor skin turgor.
I agree that aggressive use of this technique in the advancement blind is unacceptable.
Gwen Irwin
Austin, Texas