Forum topic

 I need to learn about the insertion and care of PICCs and ultrasound guided peripheral IV access.

I learn best by video demonstration, but books, dvds, online videos, online courses, websites (free info etc) and feedback from users here is most appreciated.

I have no plans on actually inserting PICCs or ultrasound peripheral IVs myself, but I may have to nonetheless, but in any case I must become as knowledgable as I can prior to actually watching others do the procedure.

Since PICCs are a central line and if it becomes infected the purported cost may range from $20k to $50k in associated cost, and the fact that some physicians are extremely wary of these risks, this new concept (for me) of ultrasound guided peripheral IV access is very interesting and I need to know as much as possible about it.

It is my understanding that these ultrasound guided peripheral ivs are 'more difficult' than standard picc line insertions?

The problem is that I deal with a very ill population (LTAC) wherein many of these individuals have edema and co-existing morbities (lymphedema, renal failure, chf, fluid retention, diabetes etc) wherein peripheral IV access is extremely difficult as veins are not readily seen nor palpable. Some also have very tough skin (african american) wherein catheter advancement is at times difficult (the skin is so tough that the catheter literally is extremely difficult to advance, and advancing with the needle in place is not straightforward--one would think that after flashback advancing a couple millimeters and then retracting the needle 2mm but leaving it in to act as a guide does not seem to alleviate the resistance).

I have been a registered nurse for over 20years and I am familiar with some of these difficulties, but with this population the problem seems to be logarithmically compounded, so to speak (tough skin, edema, fragile veins, etc).

Any and all help regarding this matter is much appreciated.

We also do not have transilluminators, and I hear it is a 'recommendation' since 2010 by some organization, but the technology seems ineffective; however, I have heard or read someplace awhile back that the Accuvein av400 may be somewhat effective and may be 'rented' for $200/month for 12months, and if a purchase is made then those funds go toward the $5k+ cost. If it may help, it may need to be a consideration as it may not require advanced training yet build confidence and accuracy in cannulation attempts and avoiding potential expensive complications (both to the population and facilities).

The problem is compounded by a lack of nursing staff that has experience at the facility that are also willing to learn advanced techniques like PICC placement and ultrasound guided peripheral IV cannulation. The staff turnover can be high at some LTAC facility locations, like 50% turnover in 2years or less...so it puts one in a difficult situation as to whom to train and for what, from a cost-effective perspective.

All insight into this matter is greatly appreciated, whether via posts here in this forum or personal contact.