I can see not nicking the skin in the patient with thin friable skin, and a fairly superficial vessel, but I cannot imagine trying this technique when placing in patients with healthy or tough thick skin and/or a deeper vessel. At times the resistance offered by the skin and subcutaneous tissue is significant. How do those of you who don't do skin nicks handle these situations? I've tried spiraling, etc, but sometimes there is just too much resistance to proceed without the nick. Ideas?
Hallene E Utter, RN, BSN Intravenous Care, INC
There is a device called Safeguard by Datascope you can use to stop persistent bleeding. It is expensive, but the IR docs use it very effectively for femoral punctures. It is available in 12cm (for normal sized arms) and 25cm sizes (for femoral punctures and morbidly obese patients). Hope this helps.
Dianne Sim RN
CEO & President,
IV Assist, Inc
Dianne Sim RN, VA-BC, CEO; IV Assist, Inc.
The Arrow MSt kits virtually eliminate the need to make a skin nick even when we place the huge reverse tapered power piccs. My past experience of making a skin nick led to many situations where the bleeding was just more trouble that the skin nick was worth.
I placed a picc a couple of weeks ago that just kept pouring blood. I mean literally pouring puddles. We tried everything to stop the bleeding dressing wise. We sent the patient down to vascular for them to cauderize the insertion site, and the doc doing the procedure found that I had inadvertently nicked a very superficial artery while doing my skin nick, and it would not clot, despite the fact that the mans labs were fine. We ended up taking the picc out since it just would not stop bleeding. It was a mess! Just an experience to share!
I have found that not making a skin nick greatly reduces any excess bleeding from the site. We also place the BioPatch after insertion and this seems to soak any oozing or bleeding that we might have.