Are any Vascular Access Teams providing PICC placements 24 hrs, 7 days/week? Our Trauma II hospital is requesting this for not only our traumas, but for our sepsis protocols and critical patients as well.
I think this is a reasonable request given your patient populations. I am most familiar with the PICC insertion service begin provided by the infusion team which is 24/7/365. Lynn
At that time, this was about 300-bed community hospital. They have changed their staffing a lot since then but I think they are still 24/7, although not totally sure. But trauma and critical care patients could need this service 24/7. Lynn
Just an additional question....If you offer a 24 hour service...does your IR Group also offer 24 hour coverage to assist with placement issues 24 hours? I have issues with a malpositioned line placed at 12MN being left till the next morning becouse IR did not deem the reposition worthy of a call-in. Looking forward to responses.
That was not an issue that I can recall. IV nurses inserting PICCs were assessing chest xrays and starting therapy if in the correct place. If not in the correct place, we worked with it until we got it in the correct place and if that did not work, we made a decision about what to do at that time. During this period, we did not have IR at this hospital, so no one in Radiology was placing lines of any kind. I can see where it could be an issue but I would want to meet the majority of patient needs as the goal. If you are placing an average of 3 PICCs per night for a total of 75 to 90 per month and you have problems with only 5 to 10%, then why should the other 90 to 95% be denied the use of a PICC just because their need occurred in the middle of the night? Why should the majority have to receive multiple peripheral sticks for irritating drugs because there is a small percentage where there might be an issue with correct tip location? I would choose to meet the needs of the majority and deal with the miniority on a case by case basis. Lynn
I worked a PICC travel contract on a team providing 24/7 service. My position covered night shift, placing PICCs solo. The PICC nurses in this hospital did not provide peripherals at all, so if the reason for the PICC order was "hard stick" the pressure was on to get that line in! They used Sherlock and everyone on the team took the Hadaway course for tip verification so lines could be cleared for use immediately. Malpositions happen, the general practice is to place the patient as upright as possible, power flush, and re-xray in a couple of hours. If immediate access is required they do an overwire exchange of the purple Bard picc and place a white poly per-q-cath trimmed to midline. The staff has been trained to recognize the purple is central the white is midline. I personally can recall only one line I could not get to reposition and IR did an overwire in the morning. PICCs were often placed in the ED, if the patient was in a room closed off only by a curtain I would request they be moved to a treatment room or if reasonable, wait until the patient was admitted to an inpatient room. The hospital uses hypothermia protocol for cardiac patients, those lines were considered "stat" or more precisely - ASAP to get the access before the veins go into hiding.
As for the business end of a 24/7 service, this staff is on salary, they are free to go home when there are no lines pending and do take call. It is a nicely managed team.
Karen, we are a vascular access company that provides 24/7 service to hospital facilities. We use the exact critieria you described for night shift coverage for PICC line insertions for septic, trauma and critical care patients. where are you located?
Congratulations to you and your team that your hospital recognizes your specialty as a value to the patient. We have been asking for a 24/7 team for more than a year, or at least can we cover some hours on the weekends. Currently M-F only, 600 beds, Trauma II hospital. ER and the units are begging for extra coverage. (heavy sigh . . . )
I think this is a reasonable request given your patient populations. I am most familiar with the PICC insertion service begin provided by the infusion team which is 24/7/365. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
How large is your facility?
At that time, this was about 300-bed community hospital. They have changed their staffing a lot since then but I think they are still 24/7, although not totally sure. But trauma and critical care patients could need this service 24/7. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Just an additional question....If you offer a 24 hour service...does your IR Group also offer 24 hour coverage to assist with placement issues 24 hours? I have issues with a malpositioned line placed at 12MN being left till the next morning becouse IR did not deem the reposition worthy of a call-in. Looking forward to responses.
That was not an issue that I can recall. IV nurses inserting PICCs were assessing chest xrays and starting therapy if in the correct place. If not in the correct place, we worked with it until we got it in the correct place and if that did not work, we made a decision about what to do at that time. During this period, we did not have IR at this hospital, so no one in Radiology was placing lines of any kind. I can see where it could be an issue but I would want to meet the majority of patient needs as the goal. If you are placing an average of 3 PICCs per night for a total of 75 to 90 per month and you have problems with only 5 to 10%, then why should the other 90 to 95% be denied the use of a PICC just because their need occurred in the middle of the night? Why should the majority have to receive multiple peripheral sticks for irritating drugs because there is a small percentage where there might be an issue with correct tip location? I would choose to meet the needs of the majority and deal with the miniority on a case by case basis. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I worked a PICC travel contract on a team providing 24/7 service. My position covered night shift, placing PICCs solo. The PICC nurses in this hospital did not provide peripherals at all, so if the reason for the PICC order was "hard stick" the pressure was on to get that line in! They used Sherlock and everyone on the team took the Hadaway course for tip verification so lines could be cleared for use immediately. Malpositions happen, the general practice is to place the patient as upright as possible, power flush, and re-xray in a couple of hours. If immediate access is required they do an overwire exchange of the purple Bard picc and place a white poly per-q-cath trimmed to midline. The staff has been trained to recognize the purple is central the white is midline. I personally can recall only one line I could not get to reposition and IR did an overwire in the morning. PICCs were often placed in the ED, if the patient was in a room closed off only by a curtain I would request they be moved to a treatment room or if reasonable, wait until the patient was admitted to an inpatient room. The hospital uses hypothermia protocol for cardiac patients, those lines were considered "stat" or more precisely - ASAP to get the access before the veins go into hiding.
As for the business end of a 24/7 service, this staff is on salary, they are free to go home when there are no lines pending and do take call. It is a nicely managed team.
Jill, Where are you located?
Cheryl E. Aldo, RN, BS VA-BC
Cheryl, you can catch me at [email protected] The team I described is in Texas.
Karen, we are a vascular access company that provides 24/7 service to hospital facilities. We use the exact critieria you described for night shift coverage for PICC line insertions for septic, trauma and critical care patients. where are you located?
Mary Santiago RN CRNI VA-BC CEO
Karen,
Congratulations to you and your team that your hospital recognizes your specialty as a value to the patient. We have been asking for a 24/7 team for more than a year, or at least can we cover some hours on the weekends. Currently M-F only, 600 beds, Trauma II hospital. ER and the units are begging for extra coverage. (heavy sigh . . . )
Carole