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mollyj
stylet wire

What do you do with the excess stylet wire once it is inserted into the catheter for placement? 

We have been curling the extra length, kind of like curling ribbon. Does anyone else do this and if so, have you noticed it leaving a tiny hole in your glove?

Thanks for your input.

lynncrni
At no time should you ever

At no time should you ever cut any stylet wire or guidewire! These are not designed to be cut and do not include anything in the instructions for use about cutting them. So any negative outcome that could occur from your cutting will rest totally on your shoulders and the manufacturer will be excluded from any legal proceedings. Cutting them is very dangerous. There are many designs of stylet wires. Some are twisted wire and some have different components welded together. Guidewires are specially built with a small wire wrapped tightly around a mandril wire. Guidewires are intended to be inserted into the vein alone while a stylet wire is intended to remain inside the catheter lumen and never to be advanced into the vein alone. I am curious as to why you think you need to cut the wire. Are you possibly using a procedure tray for insertion at the bedside that has a wire of 130 cm length? This wire is not intended for bedside insertion and is used in radiology under fluoroscopy. Do not use these long wires at the bedside because they can increase your risk of advancing the wire too far without the benefit of fluoroscopy. Get a kit with a shorter wire. They are available from many manufacturers. 

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

joelbcruz
Stylets are only used also

Stylets are only used also to keep the catheter a lil bit more stiff as you insert t into the vein.  I agree totally with Lynn H. If your catheter was designed with a stylet, use that stylet only.  Lets say you have a 60 cm line with stylet, and you measured your patient requiring a 37 cm PICC line, you prime your line with NS if required by your policy, pull your stylet back to 35 cm, cut at 37 cm mark, then advance your line in. Then once placement is confirmed, pull out stylet and dispose of it in the sharps box.  If you're doing a MST PICC placement, the guidewire should only be inserted into the vein just enough to keep it in the vein then place your dilator then introducer then pull out wire then advance your catheter.

 

mollyj
We have not been cutting the

We have not been cutting the excess wire but, curling it. THis has been done to keep the excess from flopping around.  We never cut the wire.  I was wondering what others are doing with that excess stylet wire you use to stiffen the catheter for insertion.

 

Molly Judge, RN, BSN, CRNI, VA-BC

Specialty Practice RN

IU Health Bloomington Hospital

RoseFeltner
I work with Molly and was
I work with Molly and was there the day we noticed the problem.  It has long been our practice to do just exactly what Joel decribed and we would never cut a wire.  We have a 60cm PICC and our usual length is around 40cm so that leaves around 20cm of wire extending out of the hub of the PICC.  We hold this extra wire between thumb and hard object (usually side of closed scissors) to curl it (thus making it shorter and not in the way.  Any way what we had was small holes in the thumb of her glove. This was approximately her 50th placement and the first time we had the problem.  Our concern is this something we did during the curling process or was it a glove with a hole already in it.  We have 3 other PICC nurses that do this same procedure and have never had this happen before.

Rose Feltner RN, BSN, CRNI
Speciality Practice Nurse
Vascular Access Team
Indiana University Hospital Bloomington
[email protected]

lynncrni
I am still confused about

I am still confused about why 20 cm (8 inches) of stylet wire extending from the external end of the PICC would be in the way when you have a large sheet drape and sterile gown.  Is contamination of this wire the primary concern or something else? Hard objects against any glove could easily tear a hole in that glove. If this wire is a problem, why not use some type of clamp and attach it to the drape off the the side, thus eliminating the need to hold it while you are advancing the catheter? 

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

momdogz
I'm very fussy about the MST

I'm very fussy about the MST guidewire AND the catheter stylet being in control at all times.  I leave the MST guidewire in the sheath taped onto my sterile procedure area in a place that will make it easy to pull from when advancing into the needle.

And - for the extra wire of the stylet - I coil softly and tape it.  

I don't want the end of either one waving around and possibly touching below my waist or ....some other place that might not be considered within the sterile field.  Have never noticed holes, but our stylet is pretty soft and flexible. 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Chris Cavanaugh
Many stylet wires are not

Many stylet wires are not just one wire, but a wire with another wrapped tightly around it, which is why they cannot be cut.  Curling it like a curling ribbon may possibly also shred this outer wrapped wire, causing it to unravel.  The wrapped wire most likely caused the holes in the glove as you were curling it as it has lots of little ridges that you cannot really see or feel.

The safest way to manage excess wire is simply to kink it, bend it over the hub outside of the end of the PICC.  Please take a minute to read the instructions for use included in your PICC kit.  I am confident it will address manipulation of the wires, and not following these instructions leaves you open for liablity should there be an untoward outcome. 

Chris Cavanaugh, CRNI

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Gwen Irwin
As I read this, I am

As I read this, I am thinking differently than the responses.  With the external wire (stylet) adjusted for the appropriate length, I have never noticed a hole in my glove.  I routinely loop the extra portion of the stylet and bend it at the point that will not let any portion of that wire extend farther than the measured length of the PICC.

No glove holes.

Gwen Irwin

RoseFeltner
Thanks for all of your

Thanks for all of your replies.  This is not a necessary step we do but just keeps the wire from flopping around.  Again, we have been doing this for years without any holes before this. My thought is that maybe we had to much pressure during the curling or the holes were already there.  I tend to believe the holes were already there but just wanted to make sure.

 

Rose Feltner RN, BSN, CRNI
Speciality Practice Nurse
Vascular Access Team
Indiana University Hospital Bloomington
[email protected]

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