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Threading guidewire
I am new to the PICC world but was trained by a older physician in a small hospital.  He said most times the guidewire won't thread because the needle is not DEAD center in the vein.  To avoid this he goes through the vein completely and pulls back until blood is dripping well from the angio.  You can actually seen on u/s the vein "dimple" when going back through.  Have more experienced PICC nurses found this to be true?  Is this the best way to place cath in center of the vein?  Thanks for your input!
Glenda Dennis
I have found that
I have found that occasionally I go through the vein when the patient is dehydrated and must use the technique you describe.  As you get better using ultrasound however, you will find that you can tell when you are in the vein and can successfully thread the guidewire into the vein without puncturing the back wall of the vein.  I don't think a through and through puncture is best practice when it can be avoided.
In my opinion, the so-called
In my opinion, the so-called double wall technique is never acceptable. This automactically establishes an infiltration site as blood can leak from the extra puncture site. For a PICC insertion, the fluid would be entering the vein far beyond the site of this extra puncture. Hopefully this extra vein wall puncture would have time to heal before a complete fibrin sheath could develop and cause a retrograde fluid flow to leak into the subcutaneous tissue. For a peripheral catheter of shorter length (PIV or midline), this double wall technique must be avoided. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

rivka livni
For PICC it is OK to go
For PICC it is OK to go through the back wall but you should make sure that the needle you use is no larger then 20g (I am not sure why do you use angio) and that if the pt is coagulopathic you may end up with a hematoma so avoid this with those patients. Just like Lynn said never use this technique for Peripheral IV. If you are a new PICC nurse, evetually you will not need to use this technique as you feel more comfortable after 2-300 PICC insertions.
We use the 20g that comes in
We use the 20g that comes in the Bard Power PICC kits.  Do you use something different?
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