Basic technique for PICC insertion
Being able to teach as well as perform insertion of a peripherally inserted central catheter or PICC is a basic skill needed by medical interns, radiology residents, as well as practicing physicians. The purpose of a PICC is variable and ranges from measuring central venous pressure to evaluating volume status to drug delivery. A few simple steps should allow one to effectively teach another medical professional this basic technique.
Instructions
Prep the Area
1. Teach your pupil that proper sterilization prior to any invasive procedure is the cornerstone to proper patient care. Have the pupil wash the area with alcohol solution and place proper sterile dressing around area for insertion.
2. Demonstrate ultrasound technique for locating peripheral vein.
3. Have pupil open PICC kit and draw up 1 percent lidocaine solution and inject into skin over area where the peripheral vein was isolated to anesthetize area. Wait 30 seconds.
4. Allow pupil to insert needle and stylet provided in PICC kit into the lumen of the vein under ultrasound guidance.
5. Observe pupil stabilizing needle while removing stylet from needle lumen. Then have pupil replace stylet with guide wire.
6. Monitor pupil as he or she advances the guide wire to the point where the vein enters the heart. Use fluoroscopy to monitor wire placement. Measure the length of wire used.
7. Instruct pupil to remove the needle while stabilizing the guide wire.
8. Have pupil thread dilator onto guide wire, insert into lumen of vein, and then remove guide wire.
9. Instruct pupil to insert premeasured catheter into the dilator while monitoring advancement with fluoroscopy.
10. Have pupil remove dilator and suture catheter in place.
11. Instruct pupil to open catheter line, inject heparin solution into catheter, and then clamp line closed. Apply Tegaderm dressing to finish procedure.
12. Commend your pupil on a job well done.
Tags: guide wire, Have pupil, Instruct pupil, into lumen, into lumen vein, lumen vein, needle while
