Piccing on me

This past week was entirely devoted to PICC (peripherally inserted central catheter) training. Quite terrifying since, ultimately, the goal is the thread the catheter from the basilic vein (ideally) just above the elbow on the inner arm to the superior vena cava just over the right atrium of the heart. This isn't exactly the complexity of a surgery, but it isn't as far off as I initially thought.

First, PICC placement involves complete and total sterility. What this means is a series of very VERY specific ways to do things to not contaminate your sterile field. You have to open sterile packages onto a sterile field without contaminating the field by actually touching anything within the field (including the things you are dropping onto the field). If things fall outside of the field, they go in the trash. If you touch inside the sterile field, you risk contaminating the whole thing and having to toss the whole lot and start again. Then, you yourself need to become sterile which involves a gown you cannot touch the exterior of and putting on sterile gloves through said gown (to mimic this at home, try putting winter gloves while your arms remain on the insideof a long sleeved shirt). You also have to be sure to drape the patient appropriately and not touch them or the bed shile sterile.

Once you are in your sterile gown with your surgical hat and mask on (including a plastic face shield) and you are gloved up, you can finally touch the things in your sterile field. There are too many things to really bother naming (and it wouldn't necessarily mean much), but suffice to say they have to be set up in a certain way and there is a specific order in which you progress through the procedure. It is a bit stressful trying to remember all that........especially with the patient awake and often alert waiting for you to begin.

Also, part of the procedure is using an ultrasound to locate the veins you are going to access. I fully appreciate the techs and other medical professionals that have to deal with them. It isn't always as clear a picture as one could hope for honestly. It is a lot of grey and black and exceedingly grainy. Like playing an old Caleco game on a black and white tv.

The actual procedure (don't read this if you are sqeemish............you've been warned) involves accessing the vein with a large needle that you place with the aid of the aforementioned ultrasound, then threading a wire into the vein and removing the access needle. After that, you place a larger holder in place over the wire and into the vein after making a small incision at the access point. You then de-access the guide wire and thread the catheter anywhere from 45-55cm in (depending on the person) and try to place it in the superior vena cava over the Right atrium of the heart. Then you wait for radiology to let you know if you hit the right spot, or if you need to pull it back/advance it. All in all, it can take anywhere from 45 minutes to 2 hours or more. I certainly NEVER expected that I would be doing something like this.

Another week begins soon enough. Now back to trying to figure out the clinical side of things.