I am conducting a survey of what hospitals currently using additional wires (i.e., long guide wires) to help facilitate PICC line placement when all other options fail. Currently our facility uses the BARD 70cm long radiologic guide wires to help guide the PICC in a downward location. We initially try other options, but as I stated when repositioning, flushing, etc. fails, then we do use the long guide wire. We would like to know if there are any other facilities in the US who use the Bard 70cm long guide wire for the same purpose and if they have had any issues with safety using these by the bedside.
Virginia Beck
University of Michigan VAST team
I am not aware of any hospitals that allow the advancement of a guidewire passed the axilla/shoulder outside of fluoroscopy. I would recommend that you look closely at the instructions for use with this wire. Does it say anything about use only under fluoro? If so, your practice is off-label and you are assuming all liability for its use. Also, pay close attention to the 2016 INS standards when they come out in Jan. 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
I have heard what Lynn says often from VAT's at different hospitals. However, I have personally worked at hospitals that used a 70" 018 wire to assist with placement. I was trained at a large city hospital system that taught me to use wires....so yes it is done. I'm not sure why the objections. I never read anything that says DO NOT USE WIRES....I'll wait to read the new INS standards that Lynn speaks of, but I have to tell you I'm not sure how you can have a high success rate WITHOUT the utilization of the guidewire. Be mindfu, it is not a Seldinger technique. Your wire is not used for location marking....it is only used for guidence. So Virgini, your not alone.
Jack
I thought 70 cm was the standard guidewire length. All Lynn said was that guidewires should not be advanced beyond the axilla without real-time radiography (fluoroscopy). Of course guidewires are used by nurses at the bedside as part of Seldinger, MST, and AST. The procedure is described in multiple publications including Alexander's Infusion Therapy 3rd ed. I am not understanding how using a guidewire without fluoroscopy is helpful anyways. How do you know the wire is even in the right place before you start threading??
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
Picc's usually come with a pre-loaded stylet. The length of that , I don't know I actually got rid of the stylet. My team and I think it doesn't help. There is a wire 45cm with a floppy end that is used as an introducer wire. That wire is used to keep purchase on the vein once you remove the needle. The wire I'm speaking of is a .018 wire sometimes called a "Rad Wire". This wire also has a floppy end and comes in different lengths. I negotiated that wire into our kit. It allows you to navigate past narrowing or scar tissue, whatever...to help guide the PICC down the SVC. It has been know to help decrease malpositioning. We affectionally call it the "Friday Wire". You can guess why. It does work. I've worked with PICC nurses that swear by it. Now I have had nurses at other hospitals say you can't advance past the axilla...that is perplexing because I'm not real sure what advancing beyond the axilla would do?...These tips are incredibly flexible and could in no way puncture anything. I took that wire and literally jabbed at my face several times..and That's why I look like I do now....no just kidding, but I did, I didn't even feel it...so I hardly think it would puncture a vessel. It's just another tool in the VAT nurses bag.
Jack
Why do you get rid of the stylet? Bard has improved the stylet with the 3cg piccs and it is awesome, Medcomp has a really good stylet, in my opinion the best on the market. If you're using AngioDynamics with that odd twist stylet, never mind, I'd toss that thing too. just curious.
The access wire that comes with out insertion tray is 45cm long. I will sometimes use it or an 0.035 (single lumen only) to provide additional support for catheter advancement, but pre-load it (prior to insertion) and secure to ensure it remains inside the catheter (like the preloaded stylet).
Keely
Keely Ralston RN-BC, VA-BC, CPUI, RCIS
Hi Jill,
We don't use the styley because we don't use 3CG...I think in the future everyone will go to a tip locator. But, for now, they won't let us trial that. So the styley in our PICC's is the manufactures stylet. It does add rigity to the line but we find it easier to go soft and just use the .018 wire if needed. Of course, once you use it , you'll use it with every insertion. By, the way I like your dressing and wanted to trial that....but.......
Jack
Are you using the 0.018 wire as a stylet or advancing beyond the PICC and using it to guide your PICC?
the latter....it works very nicely on those tough threads.
Jack