Hello-
My team is looking into placing 6cm PIVs but because it is such new technology, I am unable to find a lot of research/evidence with these. So far, 2 companies have peaked my interest by developing this type of IV. Bard has the Accucath and Teleflex has the extended dwell catheter. Both have a guidewire for placement and ideally you would need ultrasound to insert it.
My most pressing question would be, what is the advantage of placing a 6cm line over the 4.8cm lines? The 4.8 cm angiocath is considered standard for UGPIV placement? What is the theory? Has anyone tried them or had success?
Thanks,
Beth Thivierge RN, VA-BC
Maine Medical Center
Portland Maine
[email protected]
207-662-6029
Depth of the vein being cannulated is the major factor that drives the catheter length to be chosen. There should be ⅔ of the catheter length inside the vein lumen. When cannulating deep veins (those under muscle tissue) or superficial veins of barbaric patients with excessive SC tissue, there is a need to use longer catheters. High rates of infiltration/extravasation is associated with USGPIV and using a catheter that is too short. This ⅔ length is referenced in the INS standards due out in January 2016. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi. The team I am part of started a program utilizing 8cm and 10cm catheters (wire guided) which were chosen based on angled of insertion, depth of vein and minimum length of catheter to get at least 50% of the catheter in the vein. We reviewed several products get to this point. Things are moving along and we are being successful especially when a standard PIV is not possible and a PICC is overkill.
David Dempsey MS, RN
David,
I have been very successful in obtaining access in the forearm with a 5cm PIV with the desired 2/3 of catheter in the vein. All of the "PICC" companies have put out longer IV's/midline/extended dwell catheters, but I feel that they fail to provide a device appropriate in length for the forearm, and this leads clinicians to place unnessary catheters to the upper arm vessels. Of course assessment of the infusate and duration are key, but I make my team justify why they ruled out using a long peripheral in the forearm before they go to use the veins above the antecubital area. Clincically indicated site rotation has opened up a entire new window into device selection. I can now bring a patient through 10 days of antibitic therapy with 2 PIV's (each lasting approx 5 days if not longer). Just food for thought... but the companies need to address the forearm or many teams will not look or perfect the skill of US PIV's which in a very large percentage of the difficult access population is all they really need.
'
Glad to hear of your success. We have a little different approach in that we do not place these devices in the upper arm. We will address other types of access at this time for the upper arm. We do not currently have a large population to put these devices in as the traditional insertion method (without U/S) is our first method used.
What angle would you insert the 5cm device at and what is the deepest the vein can be to allow 2/3 of the catheter to remain in the vein for your catheter? Do you place many U/S PIVs compared to the traditional visualize and palpate for the vein method? I would appreciate any comments or suggestions from anyone that currently places U/S PIVs.
One last question, have you noticed a decrease in your infiltration rates? Thanks for your response.
David Dempsey MS, RN
Lynn,
First and formost Happy Holidays.....I was wondering how I would get a copy of those standards. Would they be available for purchase?
The new standards will first be sent to all INS members in the same package as the Jan-Feb issue of the Journal of Infusion Nursing as a membership benefit. This journal is usually mailed out around the middle of the month. At some point in January non-members will be able to place an order at the INS website and it will be available for purchase in a printed or a pdf version. I am just not sure of the actual date this will begin. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi David,
I am not a fan of the USPIV usage that seems to be spreading. I agree with you, they are being used with Jelcos that are not long enough and often going into upper arms. One or two days later we get called for a Midline with an arm 2 times the size of the other arm. Problem is, the originators of that IV don't know what happened. It didn't take me a long time to figure out the pitfalls to USPIV insertion. That's why I'm promoting the Midline. I get 7-10 days, it's one stick I know it's 15cm in the vein and with recent studies, it can take the antibiotics that we thought for years it couldn't. It's an all around safer and more satisfying procedure for the patient. Not saying that their are teams out there not having great success with peripherals, but I try not to use that . I have taught my team the pitfalls. The good news is that the catheter companies are making products that are more designed to stay in longer. But, isn't that what a Midline does?
Jack
Hello,
We were seeing major infiltrations with USGPIVs sited in the deeper vessels of the upper arms, which were typically the basilic and brachial veins, using a 4.7 cm catheter. We have more success with the cephalic vein as it is usually more shallow. We started our midline program last August with 8 cm and 10 cm catheters and have seen our infiltrations drop to nearly zero. We do look for the forearm veins first and use the 4.7 cm catheters in the forearms, but many times the veins are not large enough in diameter for the catheters. We are using the PowerWand and have had great support from the company. We continue to look for alternatives, but have not found better options yet. The extra length and the guidewire have definitely improved our success rates in placement and length of use with less complications. We did trial the Accucath and it worked well for the forearm, but we had difficulty with kinking and infiltrations in the upper arms. We chose the cost of our current 4.7 cm catheters over the cost of the Accucath for forearm placements. Our issues with increasing use of the midlines have been education, education, education to get them placed sooner and more appropriately.