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I am not aware of any studies on this issue. I would point out to administration that physicians always have nurses assisting with the placement of a CVC. So what is the difference? I don't see any difference. That assisting person is present to manage the needs of the patient during the procedure, needs that the person in sterile attire can not possibly manage.

Just to play devil's advocate, I can also see the need for weekend coverage. Without it, patient care is not the same standard for all days of the week. So it sounds like you need additional staff. Could your dept be funded to have an unlicensed assistive person as the second person rather than another PICC inserter? That may be a good compromise and still meet the needs of the patients, administration, and professionals. Lynn 

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

www.hadawayassociates.com

We use two people for each insertion but it is most often NOT two PICC nurses.  We use a nurse aide, the patient's bedside nurse, student nurses, whoever is available.  They place the tourniquet for us, assist in repositioning of the arm and/or patient, and gather additional supplies if needed.  I feel that doing an insertion all by yourself increases the risk of contamination although I know many places do this routinely.  You are correct that having two PICC nurses is wonderful but not always practical.

We now do PICCs 24 hours a day - the biggest hold-up was not having a radiologist in-house to read the CXR but our rad. dept now contracts with a virtual radiology service that reads films on the night shift so we always have the ability to get the film read.

As your hospital uses PICCs more and more, you will be pushed to increase the coverage for placing lines, and really, that is what is best for patients - fewer central venous caths, fewer complications, etc.  Lynn's idea of adding a UAP is a good one.

Hi, Karen:

Many of us have placed them independent of assistance before, but we all agree it's more efficient, and safer for the patient, to have two of us.  Once the inserting clinician is putting the dressing on, the 2nd person can be cleaning up, filling out xray req, and getting ready for the next patient.  We also have the 2 complete a short IHI type bundle that includes a "golden moment", sterile technique observed, caps/masks, and sharps/wires count - and having the second person is essential for this.

Perhaps you could use some of the IHI information; check out their website.  It worked to reduce CRBSI's in the ICUs......and required more than one clinician.

I've tried using nurse aides from the floor or other untrained nurses, and it's too nerve-wracking.  They are not trained in sterile technique (unless they're ED or ICU RNs).

We have a large team though - a full IV Department with at least 12-15 nurses who have completed full PICC competencies. 

We keep close track of our infection control and placement success rates, and more.  I can't refer you to any specific articles, but if it was helpful I could send you some of our data - would be great if we could publish it soon!

Mari Cordes, BS RN