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DENISE123
Picc insertion training

I am looking for information concerning Picc training.  How long is the learning curve?  What is the time frame expected (in min/hr) for an insertion done by a beginner?  Currently the expectation is that it will take no longer than 60 min. to do a complete Picc insertion.  Also they will be " walked through" the process by another Picc nurse once or twice, and then are considered to be able to do 3 Picc's consecutively (1 stick). How do other facilities train their Picc nurses?  How long does it take before they are up & running on their own and considered "qualified".   What problems have you run into and how did you solve them.  We will be using the Bard Site-rite ultrasound machine as well as their Picc kits.  I would appriciate any comments and advice concerning this as quickly as possible because we will be having a meeting Thursday morning on this subject.   Thank you all in advance for your help.   MDS

Those who wish to contact me direct via email:  [email protected]

lynncrni
 Learning how to insert PICCs

 Learning how to insert PICCs requires multiple steps. The first step is for your faciity to identify the level of experience required to begin the process. This may include the individual's success rate with inserting peripheral IV catheters or the amount of experience in managing CVADs. The second step is to obtain the required knowledge from a CE course. This can either be taught in a traditional classroom or obtained through an online learning method or from a computer-based course on a DVD from a PICC manufacturer. This is much, much more than inservice training on the specific brand of PICC you are using. This should be a course that encompasses anatomy, physiology, indications, contraindications, insertion techniques, infection prevention, all aspects of nursing care and complication management. The third step is a precepted period when the learner is doing insertions under supervision from an experienced PICC inserter. Your facility should establish the number of successful insertions required before you can practice independently. This may require upwards to dozens of insertions before you are successful with ultrasound use and MST. Your facility must have a method for documenting your initial competency with this procedure. The fourth step is assessment of ongoing competency which should be a dynamic process that is tied to the clinical outcomes for your PICCs. The Infusion Nursing Standards of Practice has an expanded section on Competence and Competency Assessment. Additionally policies and procedures must be written and approved before a PICC insertion program can begin. Also see INS Standards on many aspects of clinical practice. Good luck with your new venture. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Davidson
Ongoing competency

Does any facility actually state a number of PICC placements per year to validate competency? 

Beth Davidson BSN RN CCRN
PICC RN

lynncrni
 That is not the best

 That is not the best approach to competency assessment/validation. The intital competency for PICC insertion should be comprehensive with the educational component and supervised clincal insertions on real patients for a specific number. This number is not established through evidence based practice. So hospitals pick a number they are comfortable with. This could range from 3 supervised successful insertions up to a dozen or so. Ongong competency is tied to your outcomes. There is no valid reason for having PICC inserters go through a PICC insertion demonstration to an instructor on a mannequin on a periodic basis. The inserter is doing this daily in the real world of work. Instead look at your outcomes to determine what insertion and care related problems you are having. Then change your competency assessment periodically based on those outcomes. Requiring a specific number of PICC insertions will not accomplish your goal of process and outcome improvement if the same bad choices, actions, or decisions are perpetuated. See the Infusion Nursing Standards of Practice, 2011, #6 Competence and Competency Validation, page 11. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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