Are you able to insert in the upper arm? Are you accessing with a 7cm 21guage needle? Most nurse placed PICC kits come with a short 22guage angio and a long 7cm 21gauge needle. Which one do you choose? Do you use the “over the Needle” technique or the Modified Seldinger technique? If the vein is visual and palpable, we have been taught to use the short 22g angio. When placing the PICC in the antecubital area the catheter can move in and out every time the patient bends their arm. This piston effect is being looked at as a potential cause for catheter related infections. Microorganisms can enter the puncture site with the movement of the catheter. If you can access the Basillic vein up higher in the arm, you can decrease the movement of the catheter. You will need to be come skilled at the use of ultrasound to locate the vein. Use the 7cm, 21g angio for accessing these deep veins, esp the basilic vein. Place the Catheter higher up the arm can prevent the piston effect, but can also be more comfortable for the patient who is very active.
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