Forum topic

We get a pharmacy printout every day of all the IV meds each patient is on. We quickly go over it looking  for PICC possibilities.  i.e.  pt on vanco,  2-3 antibiotics at a time, etc. We will then inquire with the pt nurse if they think the patient is a good candidate for a line.  We also are availiable for hard PIV sticks which puts us in a good position to pick up on the harder  cases and initiate the PICC process before the weekend comes.

A more proactive approach to identify patient candidates for PICCs as early as possible after admission will improve this situation - the right catheter in the right patient at the right time. I teach primary care nurses when it is not appropriate to continue using a short peripheral catheter. When they identify a patient that falls outside of the parameters for a PIV, they are taught to call the vascular access nurse for a consultation, detailed assessment and soliciting the order from the physician. Those parameters include therapy longer than a week, pH less than 5 or greater than 9, osmolarity greater than 600, poor skin turgor, limited number of peripheral sites. Lynn

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

www.hadawayassociates.com

I am a one person PICC team, also.  I, too, am sometimes a softy, but if you lay down some ground rules, it will be better for you.  The doctors have signs in their team rooms stating that a patient will have a better chance of receiving a PICC the same day if they order before 1200, and that no lines will be started after 1500. I also reinforce these things verbally from time to time. 

I also gave an inservice to the residents, which seems to have helped in many areas.  We talked about reasons to order a PICC, as well as assessing patient for access needs starting at admission. 

Also, when the docs call or order a PICC, even if it is early, on a busy day, I let them know I may not have time for the line today.  A little realism.

I have the patient census printed to my office, and look over patients and diagnosis, and approach the docs if I think a patient could benefit.  Usually I am too busy to actually look over the lists, but I do occasionally. 

The bedside RNs are pretty good about advocating for the patients and asking the docs to order PICCs. 

I have found that inserting PICCs is physically and  emotionally draining sometimes, and you have to say no and stop your day at some point. 

I hope some of these ideas will help you.

Gretchen 

been there, done that.

i agree with what has been written already.

getting out on the floor and working with the nurses and talking with the drs about early intervention,  instead of 3-4 piv in 3-4 days, do a picc. 

early recognition is the key and you have to start it.  good luck

and sometimes you just have to learn to say no.(once in a while, another word or two as well)

The real costs of turfing patients to a later time or to Radiology would make for a very interesting study, IMO. For example, how many PICC teams are Monday to Friday with no weekend coverage and what is the "cost" of waiting from 3pm on Friday until Monday. We say that PICC's are the standard of care but in the same breath they aren't an emergency. Are the best standards of care limited to weekdays?  In lots of places, they are. 

By real costs I don't mean just money; what is the cost of delayed discharges? Central lines placed when the PICC team isn't available? Delayed or poorly managed IV therapy (i.e, using PIV's for PPN etc.) and what part of all that does the patient have to pay in burned veins, pain, etc. We already know that IR placed PICC's generally are many hundreds of dollars more expensive.

Ideally, better planning and early assessment are part of the answer but we need to be realistic that running a service 5 days a week without backup does have it's "costs."

Rich Lewis, RN

We have expanded our service hours to include weekends.  For years, the demand didn't indicate a need.  BUT finally it did.  We did have patients there over the weekend waiting for PICCs.

Weekends can be busy now.  However, there are patients that have been hospitalized for over a week that are now weekend candidates.  This is an indication that we have not progressed to early assessment for the right line.

We hope to improve the assessment of patient's needs earlier.  We have many RNs advocating for patients and still see patients that have been hospitalized for some time and that have been stuck for peripherals numerous times.  This is what we would really like to change.

 Gwen Irwin

Austin, Texas

 We operate  7 days a week for PICC insertions but at a reduced manpower rate on the weekends. We beefed up our staffing on Fridays into the later evening hours to allow for fewer PICCs falling into the weekends. It is a matter of juggling the few FTEs we are given.

We do identify patients through early assessment but find that the ID docs are holding us back for 48-72 more hours waiting on blood cutlure results.

Jose Delp RN BSN

Clinical coordinator IV Team

Upper Chesapeake Health