Forum topic

Kathy Kokotis

Bard Access Systems

Each RN can place 4 PICC lines in an eight hour day. 800-1,000 per year for an FTE

How many do you place? 

What is emergent because patients oiut of veins is emergent?  Patients out of access is emergent

kathy

Kathy,

What are your refernces for a nurse placing 4 PICC lines in an eight hour day?  I know that ther are time and motion studies for an IV start neding 30 min. each IV.  But what is the reference for the number of PICCs in an 8 hour day?

 Thanks so much!

Gwen

Kathy Kokotis

Bard Access Systems

You will all see more stat PICC lines than ever before.  RN's use US and many MD's do not.  Acute care central lines are a temporary line.  Patients need IV therapy.  Malpractice is increasing on central line MD placements.  MD's get $118 to drop an Arrow TL catheter.  Patients have no veins.  Drugs are bad.  Stat PICC's are needed and will grow.

I believe PICC teams will become 24/7 in the future.

I work at a 404-bed level I Trauma center in Kentucky. We are a Vascular Access Specialty Team, which is different from when we just had a PICC (PICC, Stick and Run) Team. There are four full-time RNs and one per diem (me) who works at least 36 hours/month. We cover 7 days a week, 12 hours a day, currently with 2 people most Mondays through Fridays. Every other week we teach an IV class for incoming nursing orientees, and we staff with three that day. We cover with one person Saturday and Sunday. We do all inpatient PICCs that can be advanced to SVC. For those that need fluroscopy, we send to I.R., which is relatively few. We do the difficult PIV insertions when no one on the floor can get them, though we do have some nurses in house using U/S for this. We consult on patients to help determine type of access needed, and we troubleshoot all vascular access. We do education for nurses and physicians. My teammates recently did a Grand Rounds for physicians on appropriate vascular access selection.

We triage our own referrals, and determine which should be prioritized, but we do NOT do stat PICCs.

Kathy Kokotis

Bard Access Systems

You are 500 beds which equates to a minimum of 2,500-3,000 PICC lines per year

You need one RN to do 800 PICC lines per year based on time and motion

A PICC line equals 2 hours and a PIV = 20 minutes

do a time and motion anaysis to evaluate your labor needs for a week and see where you stand

Kathy

We have a 25 member IV Department (in the process of changing to Vascular Access Department).  10-12 of us place PICCs between 7am-5:30pm 7 days/week, and off hours if emergent.  If we could staff up with PICC RNs, we could place PICCs from 7am-9pm 7 days/week.  We're a 500 bed teaching facility.

We do place them emergently.  I agree with Kathy; used to be we classified PICCs as non-emergent and would tell MDs that, but it is clear that there are plenty of instances where a PICC line is the best choice for vascular access.  We no longer refuse PICCs because they're needed emergently - we triage all of them and make decisions based on a thorough evaluation on a case:cased basis.

Great thing about a PICC team placing central lines - they have loads of experience/continuity.  The residents in a teaching facility don't. 

Mari Cordes, BS RN 

this thread is very interesting to read as we have many of the same problems in our facility.  I agree that "Stats" have to be looked at in a professional manner - although we do see many stats ordered on patients that have waited 24 - 48 hours for the PICC team to arrive on Monday simply because no one could get a PIV in,  we do see an urgent need for some of the piccs ordered as stats (no venous access, multiple non-compatible drips etc.).  Our anestesia department used to be called upon for the difficult PIV starts, while they are still called upon, they always defer to the picc team.  It can get frustrating because we are only a 2 person team placing approximately 115 lines per month - fitting in with Kathy's data of 1FTE for every 800 - 1000 piccs annually, but we get called so frequently to do a PIV that is getting harder and harder to keep up with things.  Leigh-Anne, would you be willing to share the information(powerpoint or whatever you used to present to the staff) you used for your grand rounds for all to review and possibly do the same in our facilities.  Thanks so much

Kathy Kokotis

Bard Access Systems

Words of advice and I know you will all hate me and I will get hate mail.  Look to the future and investigate adding technicians to do PIV's.  Reserach the Minn. model.  There are multiple facilities doing this.  The team maintains control and frees up time for higher technical based procedures. This is what the future will look.  This will happen with or without our support as the model is working in Minn. 

I used to belong at a pediatric hospital as IV/CVL/PICC team member. Our team composed of 8 nurses and 2 advanced nursing assistants.  Our facility is only a 150 bed hospital. Placing a PICC is not an emergency but if the patient is going home on abx, we'll place these lines with urgency and importance.  Im in the Norfolk/Va Beach area. Our staff has been dropped to 4 FTEs due to some transferring and some got let go.  I strongly believe that your facility needs to have more staff.  Our assistants due all IV needs of the hospital while we're tied up placing PICCs.  PICC has been increasing in need versus percutaneous lines. Are you looking for more FTEs and if so could you let me know the starting salary for I'm available for hire.

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Our data base (monitoring several indicators, on 5,000 PICC insertions performed by several well educated, experienced vascular access consultants working for my company) shows it takes 1.8 hours to place a successful PICC, 2.1 hours to attempt to place an unsuccessful PICC, so Kathy K's quote of 4 PICCs in an 8 hour shift is correct.

I believe the standard has been set ! In an honest attempt to decrease complications such as infection, pneumothorax, etc, it is our responsibility to ensure that PICC placement by a dedicated, expert vascular access consultant, using at least ultrasound and TLS, is available 24/7 to place the best vascular access device for your patient.

Dianne Sim RN

CEO & President,

IV Assist, Inc

We have a 4 nurse PICC team, and we work 9-5:30 m-f and 7a-7p on Sat & Sun.  We rotate a 7 on - 7 off work week.  We service a 230 bed hospital in South GA.  We do ultrasound guided PICC placements, and also do ultrasound PIV placements as we can.

As long as it takes to place a PICC, there is really no such thing as an emergency PICC placement, and besides if the patient is that bad, the peripheral circulation will be shutting down and almost impossible to place anyway.  The physicians will place a central line in the IJ, and we will replace it at 7 days if the patient is still with us.  We do not place PICCs in the ED, OR, PACU, but usually do everywhere else.

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Gerald L Naftalin, DDS

I am the daily PICC team at my 150 bed hospital. I work M-F 0700-1530. I cover call 3-4 nights a week, and have one PRN that covers call opposite me. I have another PRN that will cover my daily duties as well as call as needed.  PICCs are not my/our only responsibility, our actual title is Radiology Nurse: IVs in department, Stress tests, consicious sedation, legal film copies, EVLTs (luckily, I guess, those have tapered off to almost none), etc.  And like most here, as well as PICCs, we do PIV starts too. It can get busy. Oh we will put PICCs in the ER, if the patient is going to be admitted but still needs a CT with contrast or the ED nurses couldn't get access.

The three of us just put in our 405th PICC for the year (and still have a few weeks for more)! more than any previous year. I put 300 in myself, whew sounds like a lot when I say it. an easy day is no PICCs, but the most I've put in is 6 or 7 in a day.... THAT was a BUSY day!! I read someone's post that it takes 2hrs for a PICC.... wow! I must be motoring, a non-complicated one takes me an hour with paperwork and CXR.

So any previous posts have updates?

1. Our hospital has 240 beds including maternity floor.

Average daily census: 150.

PICC insertion per year: 1100.

Difficult PIV's per year: 2500.

Daily PICC nurse: 1, Mon-Sat

Coverage time: 12 hours/day

Sunday: On-call, 12 hours.

Team: 2 FTE's, 2 Perdiem.

2. "STAT" PICC's do exist. So we do STAT PICC's. Because the budget does not allow us to have 24/7 coverage, we have to do STAT PICC that come in over night first thing in AM. Patients do suffer if we dont do STAT PICC. I have a friend who is a PICC RN. He used to argue against STAT PICC. For him, "there is not a such thing called STAT PICC" and "the only STAT PICC is the one that shove up your ***" (his exact words!!!) One day, his mother had a severe abdominal pain with fever and vomiting and brought to a local hospital. Staffs at that hospital, including RN's, ER MD's, anesthesiologist... tried many many times to get an IV access or central line. They were unsuccessful. So they ordered STAT PICC. There was no PICC RN at night. They couldn't do a CT with contrast. So all night long she suffered. The next day the PICC nurse came in and managed to put in a PICC. But it had been more than 12 hours pass and she went into septic shock. With the PICC inserted, things started moving along for her but it took almost 3 months later she could finally come home. Needless to say, my friend got a new respect for STAT PICC. I still mocked him sometimes that "the only STAT PICC is the one for your mother".

Hi Joel,

If you are still interested in a vascular access position in the Hampton Roads area, please contact me via PM. Thanks.

When your PICC service is good enough that none of your physicians have placed a short term CVC in 3 months or more, in order to meet the standard of care that you have established, you should provide a Stat PICC when needed. Whether your management or your team recognizes it, you are the central line Providers. I think regulators might have an issue with saying " we provide this standard of care, except after hours and on weekends." If you are an acute care facility with an ER, you need to be able to provide a central line when it's needed.

We had a full service IV Team until August of 2010. We now have a "PICC" team that works 8-530 Monday thru Friday. The Interventional Radiology team can place them in off hours if absolutely necessary. We average 80 PICC's per month (by our PICC Team) in our 250 bed facility. It is unfortunate to have lost a full service team as their stats were phenomenol. We had only 1 questionable CLBSI in over 15 years in lines placed by the team - but even that was not enough to save them. I am happy that we have been allowed to at least have the PICC team survive.

 I am a nurse on an IV team in York county, PA. We have a 550 bed hospital and an IV team of about 20 nurses. We do most of the IV's in the hospital and provide backup to the areas that do their own. We assess most Iv's in the hospital once daily and provide some preventative care/maintenance to the sites as well as change the outdated or 'bad' iv's. Although having an IV team is a good thing, it creates a dependence. There are nurses who call to have the IV 'retaped' or check the pump, or other issues ANY RN should be able to manage. Yes we also get calls to areas for simple access for reasons other than failed attempts. 

During the day we have 4 nurses who assess and change IV sites, PICC dressings, ports, etc. Floor nurses care for their own CVC's. On average each section of the hospital has about 30-60 sites to assess in the am and about 30ish on evening shift. We have a picc nurse (all RN's on the team are able) who does the insertions, we rotate the assignments. If we are unable, then we send them to IR

Their is no such thing a s a stat PICC! That is a dump! Piccs are not stat and we have had to explain this to residents who do not want to place needed CVC's because of reasons other than medically contraindicated. Most residents don't know that a PICC IS a central line. We do not do Midlines at all, but will pull a PICC back to axillary if unable to advance(but not very often) Luckily we have a medical director who has not only changed the Picc criteria, but has informed med residents of the need for CVC's in 'emergent' situations. 

Our hospital changed PICC criteria last year and reduced our numbers dramatically. People were getting PICCs for reasons other than needing them--nurses like to have them, patients who ask for them. Now, they have to be getting ABX for at least a week, TPN > 5days, not had Blood cultures drawn or they need to be Negative for 48 hours. GFR needs to be >30 or they get a tunnelled cather.  No more blood draws from PICCs and a few more things.  We went from about 150-170 PICCs placed a month to about 60-80. More CVC's are placed, all in all it has improved a few issues, but has also created some as well --just like anything!

Good luck!

Cheryl

we are a two fte person team in a 190 bed hospital

we place an average of 85 piccs monthly in house and another 10 OP

We also average 60 troubleshoots per month

sorry i forgot   we are geting an increase in requests from the ER but have been resisting those. 

We have an IV team that places over 1500 PICCs/year.  We have an OR team that places >250 PICCs/year.  We also have an out patient PICC program but I am unsure of those numbers.  We established the formal OR team Jan of 2010. (There are three of us).  We have policies in place for the docs to "book" PICC lines as an add on if that is all they need.  (we are a pediatric hospital). If a child will not tolerate bedside PICC or does not meet sedation requirements then they come to the OR.  (Personally I would like to see more placed in the OR or a procedure room rather than bedside.)  The most lines I have done in one day was 5. Our IR department only place the most difficult lines.  In addition we do all of the dressing changes, start the IV's in the pre-op area if warrented and occasionally we will help the IV team with PICC lines if they are short staffed.  Once a month the IV team, OR team, various directors meet as a task force to discuss issues etc.  The program has been well received and with recognition of services more popular. (It is alot easier to place a line in a child who is asleep...)

I work in a pediatric hospital, level 1, licensed for 559 beds.  Our access Team is divided into a PICC Team and an IV Team. OUr PICC team consist of approx 8 nurses, and cover 7 days a week 7a - 7p. Some of the  responsibilities include PICC placement, care and maintenance of all in house PICC's, including daily rounds on all PICC dressings, occlusion management, PICC d/c and family education. Our IV Team consist of 13, full and part time, and cover 7 days a week, 24 hours a day. We esatblish PIV's hospital wide, including ER, ICU's and clinics. We follow and track infiltrates, PIV assessments as requested, Central line repairs, and difficult lab draws. A typical month for PIV  (January, for ex) was 1450 successful PIV's. We also track our success rates, and I am proud to say we have an average success rate as a team >90%. I also would like to mention that we follow the INS guidelines, and if we attempt a PIV and are unsuccessful x2, we ask for another IV team member assist. We do not attempt more than twice, per person.

We are standardizing 2 vascular access teams to provide coverage at 3 separate facilities (740 beds, 400 bed and 150 beds) and am looking for some information from similiar programs.  Would love to hear from you and get some info on staffing plans,  duties etc..thanks!