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Halle Utter
Is there a standard number of PICCs per nurse per shift ?
A facility where I do back up contract support expects their nurses to place 6 PICCs solo per 12 hour shift.  They are also expected to carry a pager and respond to difficult peripheral sticks, port accesses, cathflos, perform the sterile dressing changes on all in house PICCs,  etc, and answer the pager.  This is also a larger facility - very spread out - so distance is an issue.  Does anyone have any good references for productivity that would be helpful in this scenario?  We all know some line placements are easier than others, and take less time, but this seems a bit farfetched to me, coupled with the other responsibilities these nurses have..  Feedback please.   Thanks.   
Karen Day
Karen Day's picture
If I remember correctly, at

If I remember correctly, at AVA it was mentioned that one picc nurse should be able to place 4 piccs/8hr shift and 5 - 6/12 hour shift.  The facility in which I work is also a large and quite spread out facility.  There are two of us on our team, but only one of us works per 12 hour shift (except on Wednesday when we overlap.  We do not work weekends)  We are responsible for everything you mentioned above except for the dressing changes.  Our floor nurses are responsible for this as it is part of catheter maintenance that they are trained for.  We also do all of the outpatient picc line placements.  I must agree with you, some days are very hectic and we don't know which way to turn first.  I will say that we are very respected by our facility and are working on training some of our more experienced nurses to assist with catheter issues such as occlusions, PAC accesses etc.  In the end, we are usually able to accomplish all that the day has to offer.  Hope this helps.

 

rosshy
Number of PICC insertions

Number of PICC insertions per shift depends on the pICC nurse's experience and easy of work flow. It can be 20 minutes or 120 in the patient's room. All depend on the inserter's experience.

Cat Johnson
Karen, Would you mind

Karen,

Would you mind delineating from start to finish your scenario for a PICC placemet?  Meaning...from introduction to patient, to final charting note, how many minutes does each step take typically?  This is important because my team seems to need more time to complete a picc insertion then average and I am wondering where we could streamline the procedure.  Thanks for your help.  If anyone else would like to add their scenario, please feel free.

Cat Johnson, CRNI

Karen Day
Karen Day's picture
We recieve our orders by

We recieve our orders by pager.  Once received, we review their H&P and labs through our computer program - Physicians Portal (approx 5 - 10 min).  We then make contact with the patient's RN to ensure all paperwork (consent etc.) is completed prior to our arrival (this step about 5 min).  Once we arrive to the floor, we pull our necessary paperwork from the chart - speak with the patient and/or family, place the line and order our CXR (about 45 minutes total for a non-complicated picc).  We usually then move on to the next patient and when completed with that patient, our CXR is usually already available on PACS with an interpretation from our Radiologist - checking this and notifying the RN that the picc line is cleared for use takes about 5 minutes.  We then chart and tube our orders to the unit (5 minutes) for a total of 1 1/4 hour per picc.  We have worked hard with our radiology techs and Radiologist to fine tune this procedure in order to deliver a functioning picc line in as little time as possible.  We also use pre-printed stickers for our procedure process and orders leaving blank lines to fill in the arm, vein, catheter type, catheter length and securing device.  This pre-printed sticker saves a lot of time compared to hand writing everything.  Granted some days don't always go this smooth and some patients take as much as 2 - 2 1/2 hours if family has a lot of questions and/or the insertion is a difficult one.  Our average number of piccs placed per day is 6 per RN as well as assisting with difficult PIV's; troubleshooting picc lines and handling the beeper. Let me know if you have questions.

 

Michael Drafz
Michael Drafz Vascular

Michael Drafz

Vascular Access Specialist

Sharp Memorial Hospital San Diego, CA

I think this number is almost impossible to come up with. Our service is very similar as the one you described. We have several people on staggered between 6am-11pm. We also use LVNs to help with PICC dressings and PIV's. Usually one or two RN's are doing the PICCs they carry a pager but do not respond to the pages, so they only take care of the PICCs. We switch that role throughout the day.

Other factors are:

- what products do you use

- what type of documentation

- how is xray verification set up

- do you use US

- how experienced is your staff and the hospital staff

- how sick and difficult are your patients (trauma, mid city, oncology ect)

I am very experienced but it has taken my anywhere from 45 min to 2.5 hours to put in  a PICC......

So in average I would say 5-6 PICC's in 8-10hours but only doing PICCs.

Michael Drafz RN, CRNI, VA-BC

Clinical Lead Vascular Access Service

Sharp Metropolitan Medical Campus

San Diego, CA

 

Paul L. Blackburn
Halle, You won't find

Halle,

You won't find specific cap recommendations in the Bard Instructions for Use for the PowerPICC SOLO*.  Bard does not make this type of recommendation as needleless injection caps are add-on devices.  This is also the thinking behind not putting a specific needleless injection cap in the kit with the PowerPICC SOLO*, however, if you go to the Bard Access Systems website, under the FAQ section, Bard does spell out flushing and locking recommendations.  Additionally Bard does recommend the use of positive pressure needleless injection caps when the clinician applies this add-on device to a Bard PICC.  This is nothing new.  Bard has been recommending positive pressure needleless injection caps for many years.  With all of that being said, Bard has found that the PowerPICC SOLO* works well with negative, positive, and neutral pressure needleless injection caps, especially if the clinician uses a good "push-pause" flush with a "positive pressure" disconnect.  The only needleless injection caps that seem to be an issue on this PICC is the split septum devices as many of these carry such a negative pressure load, they are able to over ride the valve and thus lead to blood reflux.  Please let me know if you have additional questions.  Paul

Gwen Irwin
Being part of a network of

Being part of a network of hospitals that we insert PICCs, we know about being very spread out!  We can travel between hospitals and only focus on PICC insertions.  We cannot manage any more than PICC insertions.  Without doing any of the dressing changes, occlusion management, port accesses, or IV starts, we can insert about 5-8 PICCs in an 8 hour day, depending on the travel issue.  We would love to grow to be the venous access team that does all of that, but at this time, the budget reigns and doesn't allow us to expand with more full time employees.

I am not sure that this helps, but wanted to share.

Gwen Irwin

Austin, Texas

Halle Utter
Gwen,     You can average

Gwen,  

 

You can average 5-8 PICCs per RN per 8 hour shift traveling between facilities?   I just wanted to clarify.  That's pretty amazing.  No help?  You read your own xrays, gather supplies & cart? How far apart are your facilities?  

Hallene E Utter, RN, BSN Intravenous Care, INC

Gwen Irwin
Before the last new hospital

Before the last new hospital added to our network, we were about 12 miles apart.  The coordination between the PICC nurses is amazing.  We try to keep travel to a minimum, but it is still a neccesity.

The nurses that can stay at one facility and do not travel can average doing more PICCs (obviously).  They are the ones that can do 6-8 PICCs in an 8 hour day.  We do look at our own xrays and we have improved the supply issue.  We have boxes from our supply department that include all our additional supplies that will support 2 PICC insertions, plus getting the PICC trays.  The supply issue has decreased our time significantly in getting supplies.

Also, having a tip locator has decreased our time in the sterile field.  We know that the PICC is going he right direction and complete the dressing application.  We have PACS (archival system for xrays) that gives us the image via computer quickly.  We no longer wait on elevators to go to radiology and ask the radiologist for the tip location.  We have completed extra training to determine the tip location.  That has also saved a lot of time.

Also, we have very experienced PICC nurses.  They have amazing results and great success rates.

Hope this helps answer your questions.  Please let me know if I haven't answered your questions completely.

Gwen Irwin

Austin, Texas

Jennifer
Jennifer Is only one RN in

Jennifer

Is only one RN in the room when placing PICCS? We send one RN to place the PICC and one to assist.

Jennifer

Gwen Irwin
We have 1 PICC RN per PICC

We have 1 PICC RN per PICC placement.  They have so many efficiencies built in to our system that they do 5-8 PICCs in an 8 hour day.  Some days however, they work more than 8 hours, when consents are an issue or travel is an issue.

In an unusual circumstance last summer, we had 2 PICC nurses for each patient.  One nurse was the "quarterback" and did all of the triage work and almost all of the paperwork.  During that month, 1 PICC nurse placed 11 PICCs in an 8 hour day.

Like I said, they can be amazing in their efficiency!  We have tried to create every time saving component that we can.

Gwen Irwin

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