It recently came up as a question in our PICC team, if it is acceptable to use the same needle for a second stick if not successful on the first attempt for a PICC insertion. I know the INS standard states that no more than 2 attempts should be made by any 1 nurse, so after that second stick (if unsuccessful) a new tray/set up would be used, but not sure after one stick if the needle should be changed? Any comments would be helpful....
The INS standard to which you are referring does not apply to needle use. See INS SOP #35.7 1 device for 1 attempt. 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
So are other nurses opening a new microintoducer kit (we use Bard product - kit includes needle, wire, introducer, scalpel) for every attempt. Have not been able to find out if Bard sells needles individually.
I do not open another conversion set (needle, guide wire, dilator and microintroducer) if I need a second puncture to access the vein. However, in my kit, there are 2 needles (different length) plus a peripheral catheter as inserter prefer to use this to access the vein (I prefer the needle). More over, I virtually never perform a dermotomy because the dilator and microintroducer is so slick that it goes in any type of skin without requiring dermotomy. I use the Arrow conversion set (modified seldinger).
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
I do not open another conversion set (needle, guide wire, dilator and microintroducer) if I need a second puncture to access the vein. However, in my kit, there are 2 needles (different length) plus a peripheral catheter as inserter prefer to use this to access the vein (I prefer the needle). More over, I virtually never perform a dermotomy because the dilator and microintroducer is so slick that it goes in any type of skin without requiring dermotomy. I use the Arrow conversion set (modified seldinger).
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
We do not open another stick kit. If the vein was not hit we would just make another attempt using the same needle. If the vein was hit but we could not advance the wire, we would flush out the needle and use it again. The only time we will drop another stick kit is if our wire kinks and then we would use a new needle and new wire from the kit.
There are several issues to consider. First is the infection risk. Skin organisms adhere to the device as it passes through the skin, however this introducer is not intended to remain in the vein for biofilm to develop. This could be one reason for not seeing infections associated with this practice. Second is a change in the integrity of the bevel of the needle with each pass through the skin. If you have ever seen microscopic pictures of needles after they have been used once, you would understand the tissue damage that is possible with each subsequent use. Talk to any medical device engineer and they will tell you about these changes that can happen. So increased pain and local tissue trauma can result. I would be curious to know the success rate for using an introducer for the second attempt. That data would be useful to determine if this practice is good or if we only think it is good. 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
Infusion Nurses Society, Third Edition
Infusion Nursing An Evidence-Based Approach
Copyright 2010
Section V; Page 486
States "Any time the vein is to cannulated more than once, a new needle and guidewire should be used. If only the needle is needed, echogenic needles can be purchased in individual packets as well."
Deborah Wall RNC-NIC, C-NPT
Georgia Health Sciences University
If you don't switch out needles, you might cannulate and not get a blood return even though your in the vein. Save the patient and yourself problems and use a fresh needle.