Would appreciate comments from PICC nurses about whether their hospitals send out one or two people to insert PICCS-any information about volume, acuity, transport of equipment, ,utilization of trained nurses aides, CLABs and any other pertinant issues would be very helpful. Our hospital would like us to start doing one practicioner insertions and we have many concerns.
Thanks
Ann Y
Allegheny Health System
Hi
The CDC guidelines recommend that there be an observer for the set up of the sterile field (and that person document that observation). There are times when attempting to thread the catheter you need to lie the patient flat (some patients can not tolerate lying flat for the whole procedure) or reposition the patient. Additionally if you need more saline flushes because of difficulty inserting the line or drop something and do not have someone there you will have to break your sterile field to get what you need.
2 people here. what other full drape- sterile procedure has one person? One is a tech
I work for an NHS hosp in the UK. We have just started inserting PICCs in critically ill patients in ward settings. We work on our own but always insist on having a healthcare assistant to trolley. This helps maintain sterility but the importance of having two people present - we insert our PICCs in treatment rooms off the main ward, with air recycling - was reemphasised when one patient suffered cardiac arrest! I'm amazed anyone can insert a PICC by themselves - I just don't have enough hands (and would be tempted to use my teeth on the torniquet!! : )
I regard to the above mentioned CDC guidelines: I have not been successful in finding the CDC guidelines that recommend that there be an observer for the set up of the sterilie field. Could you send me a copy of this?
[email protected]
I strongly agree that 2 people are needed to adequately perform the time outs, checklists, and meet all patient needs. This does not mean that the second person must be an RN. I know of hospitals that have trained medical assistants to fill this role. 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
We use 2 people to insert piccs. One can't be certain sterility is not broken when doing the procedure alone, no matter what one thinks. I'm sure we have all seen sterility compromised by many providers over the years. Also it's helpful to have a second person to assist with patient repositioning when there is difficulty advancing the picc, or if patient gets restless, etc. Having a trained PICC nurse to assist is even better, because they can try if one is not successful. This has saved a procedure several times for me, as I have helped others too. Of course, administration sometimes insist we just do it alone because they think it saves money. It doesn't necessarily save time or money.
2 licensed personnel that have completed competency assessment for either PICC insertion, and/or if they are assisting, PICC insertion assistant. Occasionally we will use IR MA's that we have trained to our way of doing things, but we prefer two RNs. We are very fortunate that our hospital supports this, and - our team has done an enormous amount of collaborative work in the hospital with Quality, Infection Prevention, Home Infusion Pharmacy, ICUs, Radiology and more over the past 6-7 years. Because of this, and because we have been successful at bringing our CLABSI rates to a very low level, we have made a name for ourselves and are trusted.
You'll find lots of posts on this topic, including how to make your case for enough FTEs to do the work properly and safely. A health care professional inserting a central line cannot observe themselves, so the only way to meet the checklist requirement is to have 2 people. Management is fooling themselves and is being very shortsighted if they think they can save money by only having one person do the procedure. It doesn't matter how skilled the nurse is.
When we have 2 RNs, we can "leapfrog" from patient to patient. While one is finishing up the procedure after the dressing is on, the other is heading to the next patient to evaluate with the ultrasound, get the room ready, etc. You can actually be very efficient with two RNs, and then if the 1st inserter has problems, you have another licensed, trained nurse there to step in.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
CDC Guidelines do not address this issue, however the new SHEA Compendium does have a statement. This document was first released in 2008 and has now been updated and will be released in about a month. I served on the committee to revise this new document and am giving a short presentation about it at the APIC meeting in early June. In the Basic section At Insertion, this statement is found.
"Checklist have been suggested to ensure optimal insertion practices. If used, the documentation should be done by someone other than the inserter."
So 2 people are necessary as the inserter can not complete the checklist assessing that they performed all steps.
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