We are two RN's on a Vascular team for 298 bed hospital. Two nurses work Monday through Friday placing PICC lines and difficult IV's. We stay late occasionaly until 6-8 PM if needed.
Our Administration informed us that we should not have a cut-off time for PICC consults. Our hospital does not have an IV Team providing 24/7 coverage.
We would like to know from the group if your hospital has a certain cut-off time for PICC consults and what is that time?
Thank you,
Inna Perfido, RN, BSN
Charleston, SC
I work Mon-Fri, 0800-1630, inserting pediatric PICCs. I tell the doctors that I will not start a PICC procedure after 1500 (time enough to allow for placement and confirmation for last line placed). There is only one of me, and occasionally I will stay late to place lines, but that should not be expected... I am hourly, so I get the overtime on my check.
If the Docs order a line too late in the afternoon, I tell them it will be done the following day.
Hope this helps
Gretchen
Kathy Kokotis
Bard Access Systems
With 2 FTE's is it impossible to do eary assessment so if the doctor orders a PICC at dishcharge or after venous exhaustion that is their fault. I suggest doing a review prospectively of patients on date of admit, date of PICC order, date of PICC placement and date of discharge to identify on which date the PICC patient is identified after admit. Sounds like reactive therapy to me
Kathy Kokotis
Bard Access Systems
It is my opinion that PICC placement should be available in acute settings 24/7. If a facility can make sure there is a physician available 24/7 to place a more risky CVC, surely the facility should be responding to all the studies indicating that PICC placement by a Vascular Access RN is less risky (and hence less expensive in $ and patient trauma) and ensure that there is 24/7 PICC coverage. I also think that there is such a thing as a "STAT" PICC !
You can obtain this coverage by employing per diem Vascular Access consultant(s), or contracting with Vascular Access companies (such as mine) who are available 24/7, including those times when your PICC team is overwhelmed (due to vacations, sick leave, excessive number of referrals during the day, delaying commencement of therapy or discharge of a patient)
Dianne Sim RN
CEO & President,
IV Assist, Inc
Dianne Sim RN, VA-BC, CEO; IV Assist, Inc.
So, if your hospital says there shouldn't be a cut-off time for PICC referrals, are they going to be increasing your FTEs? There's no way they can expect you guys to work a hospital that large day after day and do the overtime that's going to be required to cover their additional "requirements". You guys are going to burn out faster than fast.
Are you able to show them numbers of how many PICCs you place during your shift, let them know what ISN"T getting done because you do nothing but lines, and such?
My hospital has a 24/7 service for 260 beds, 3 RNs on Days, 3 on Evenings, 1 on nites. The nite person is getting paid to do hardly anything. It has been this way for 5 years. There is rarely a PICC after 11PM, because patients don't want to do this in the middle of the nite (our ICU usually has residents who need to get their non-tunneled line insertion skills done, so PICCs aren't usually the first choice there unfortunately).
I don't think hospitals need a 24/7 service for PICC insertions.
Just my 2 cents
Nina Elledge, RN, MBA, CRNI
[email protected]
Nina Elledge, RN, MBA, CRNI
[email protected]
We are a 450 bed level one trauma facility. There are a total of 4 fte's and one PRN that works 2-3 days a month. We usually have two PICC nurses on per day and we do 12 hr shifts 8a to 8p. We did a year long study of night shift PICC orders and found there were not enough, and being that a PICC should NEVER be a stat procedure, we decided to do away with our night shift. We trained a few key nurses on night shift to use the ultrasound for difficult peripherals and they have become quite profficient. We get our orders thru the nite, and start on them first thing in the am. We will not usually start a PICC after 6pm, but that is not policy. It's more an unwritten rule since the ones you do late ALWAYS end up being the difficult ones that keep you overtime. They do the strangest things after 6pm......
Anyway, some of the facilities in our area have out sourced their PICC's to Vascular Access companies, especially to cover night shifts. We do a whole lot more here at U of L than place PICC's though. We are a Vascular Access team of specialist, and when we get a PICC order, we consult on that patient to decide just what kind of access that patient needs. We do not always place a PICC, but when we do we follow our PICC's daily and collect data on every aspect of them. An outside company can not do that, so I worry about care and maintenence of the lines these PICC companies place. I am not saying that the companies do not do a good job PLACING the PICC's. They just do not follow them, and if the floor nurses are keeping these lines cared for, well lets just say that most everyone in the PICC field would know that that is not a very good scenario. A specialty team is ALWAYS the best team. There are too many studies to prove that already.
Good luck though. Do not burn youself out. I love placing PICC's, but I am just getting too old for all that overtime.
Heather