I just wanted to share a little trick that helped us the other day inserting a PICC in the cephalic vein of a patient who is using crutches.
The catheter repeatedly appeared to be going back down the arm on the magnetic tip locator device. Our first manuever was to retract the stylet so the tip was floppy. This did not help. We then adducted the arm which often works well but not this time. Just before giving up we had the patient turn his head to the contralateral side and then drop the shoulder on the insertion side. The catheter then easily advanced into the subclavian and into the SVC. I believe it had more to do with dropping the shoulder which theoretically reduced the angle where the cephalic joins the subclavian vein.
Just a little hint from Heloise to put in your toolbox for future reference.
D.Cole, RN, CRNI, VA-BC
I ran into this same situation last week. Try as I might could not get it into subclavin. I will put this in my "tool kit" of tricks to try.
Debra R.
Long Beach Memorial Medical Center
Debra Rivie RN VA-BC
Long Beach Memorial Medical Center
Long Beach, CA
Can you share any research on why cephalic vein placement is ok for crutch use? I have read that cepahlic placement increases the chance of DVT by as much as 30% It seems to me you are now magnifying those odds by thinking its ok for crutches. Vein compression from arm crutches is at the axilla and I have to believe that cepahlic gets compressed as well.
MHC