Cannulating a bariatric patient can be very difficult due to excess adipose tissue. It is important to do a full assessment to locate a suitable vein. AccuVein vein visualization technology can help with locating and assessing suitable veins in all patients, including those that are heavy-set or obese. But sometimes there are those cases where the veins are just so deep that the needle may not be able to cannulate as deep as necessary to reach the vein depth. In those difficult cases where a vein is not accessible Noah Sugerman, MD (EM resident, UCLA/Olive-View) and Eric Silman, MD (Assistant Program Director, UCLA/Olive-View EM residency) suggest the use of a PIPP (Peripherally Inserted Peripheral Pediatric catheter).
“The pediatric CVC is 8 cm (3.15 in) in length, which gives the extra length you need to get from this patient’s skin into the vein. As an extra bonus, this is a double lumen catheter with 18- and 20- gauge lumens… Placing this line is essentially like placing a short PICC.”