Are there any rules that specify the # of attempts (IV sticks) a picc nurse has when placing a picc? We are a 300 bed faciltiy with 1 picc nurse 7a to 7p 7days a week. I have heard of nurses having to stick a pt "multilpe" times (8,9,10x)
 Stephanie
That is excessive !!!!! I would have to say that the nurse(s) need more training. Even before we had Ultrasound my co-workers would attempt twice and call for me. I often would spend 10-15 minutes to assess for veins and evaluate all my possibilities carefully to increase my odds. It takes a lot of patience,especially when you are busy. Now that we have Ultrasound and of course after getting past our learning curve the max # of venipunctures we perform is three before the assistant helps or calls for the other PICC nurse. Again,spend whatever time you need to carefully select and assess possible veins. Here are some general considerations that our team as found out that helps us be successful. I did a bit of quick data collection recently and as expected we were able to access the vein for PICC placement with one attempt 85-90% of the time. Here are some general considerations that helped us out quite a bit. The PICC team does not carry an active pager,except on weekends. Another PICC/IV nurse answers all the calls and can get in touch with them. This really decreases the stress on them and they really can focus. I also know when to tell them about incoming new orders. I would never call them in the middle of a difficult insertion. Next, we have discovered that pre-medication with ( narcotic,anxiolytic) really helps. Our patients tend to complain about shoulder pain and not the stick. A comfortable patient is a cooperative one. We limit traffic into the room by placing a do not enter sign on the door. I do not like the TV too loud but if it keeps the patient calm I can live with it. Fuss with the arm position to optimize your success.Have your more experienced nurses keep traing those that are not. When I am nurturing someones skills I call them in on difficult or interseting cases and instruct as I go or ask another senior PICC nurse to do so. Do these nurses ask for more training b/c if that was me I would be begging for some b/c that sounds so stressful and unproductive. What can you do to improve this?
Our policies state that PIV whould be attempted no more than 6 times (2 sticks per RN). AND our PICC policy is limited to 4 sticks.