I would like to get opinions on when an attempt is truely and attempt when starting a PICC. So is it with a needle pass through the skin, wire pass, dialation, or threading the PICC?
I agree, once you have entered the skin the attempt has begun - successful or not. However, we go further to state how many sticks are done with each attempt at a picc line. for example, if we successfully place a picc line and enter the vein on the very first stick (which usually happens 97% of the time) we count that as one attempt with one stick. If we miss the vessel, have guidewire or dilator issues and have to re-stick the patient and are successful, we count that as one attempt, 2 sticks. All picc insertions attempts successful or not are documented as so with the corresponding # of sticks if applicable.
So if it took TWO sticks to get a PICC in, your documentation should say "It took two attempts to insert a PICC" or "Successful PICC insertion was achieved on second attempt"...and so on and you could discuss in your comments whether it was a problem with the vein isolation, the advancing of the guide wire, peelaway/dilator insertion or if it was the advancing of the catheter itself that was the problem. But two sticks are two attempts.
we ALWAYS chart in our comments why we had to stick the patient more than once so that the physician and staff know if it was a vessell issue, guidewire issue or if the picc is not passable beyond a certain point. We just want to clearly define when we have to stick a patient more than once and this is just our way of doing it.
This question reminds me of another scenario I have encountered.
Many times an IR department won't insert a PICC untill the bedside team has "attempted" and failed.
I recall having a little confrentation at an account where I was doing trinaing. We told the IR department that we "assessed" the patient and determined that there were no vialble PICC veins.
The IR doc insisted that we at least "try" before sending the patient down. I wondered out loud, "do I need to make the patient bleed to get you consider another kind of line?"
In this department's mind, if you didn't break the skin you hadn't attempted or tried.
A good assessment of the venous status should have been enough.
An hour later, after lunch, we told them that we tried and failed.
Mike--You are in good company--I know many nurses have used the same language to circumvent the IR and save the patient a meaningless venous insult--That is a true demonstration of autonomy
In my opinion, once you have entered the skin, the "attempt" has begun. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
I agree, once you have entered the skin the attempt has begun - successful or not. However, we go further to state how many sticks are done with each attempt at a picc line. for example, if we successfully place a picc line and enter the vein on the very first stick (which usually happens 97% of the time) we count that as one attempt with one stick. If we miss the vessel, have guidewire or dilator issues and have to re-stick the patient and are successful, we count that as one attempt, 2 sticks. All picc insertions attempts successful or not are documented as so with the corresponding # of sticks if applicable.
karen
To me, entering the skin for a 2nd stick would constitute a 2nd attempt.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Lynn, you are absolutly right.
Karen, Breaking of the skin IS an attempt.
So if it took TWO sticks to get a PICC in, your documentation should say "It took two attempts to insert a PICC" or "Successful PICC insertion was achieved on second attempt"...and so on and you could discuss in your comments whether it was a problem with the vein isolation, the advancing of the guide wire, peelaway/dilator insertion or if it was the advancing of the catheter itself that was the problem. But two sticks are two attempts.
we ALWAYS chart in our comments why we had to stick the patient more than once so that the physician and staff know if it was a vessell issue, guidewire issue or if the picc is not passable beyond a certain point. We just want to clearly define when we have to stick a patient more than once and this is just our way of doing it.
This question reminds me of another scenario I have encountered.
Many times an IR department won't insert a PICC untill the bedside team has "attempted" and failed.
I recall having a little confrentation at an account where I was doing trinaing. We told the IR department that we "assessed" the patient and determined that there were no vialble PICC veins.
The IR doc insisted that we at least "try" before sending the patient down. I wondered out loud, "do I need to make the patient bleed to get you consider another kind of line?"
In this department's mind, if you didn't break the skin you hadn't attempted or tried.
A good assessment of the venous status should have been enough.
An hour later, after lunch, we told them that we tried and failed.
The patient got a tunneled catheter.
Mike Brazunas RN
Clinical Specialist
Angiodynamics
Robbin George RN VA-BC