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FRENCHCONNECTION2000
IVT Team Transisition to PICC TEAM
I was wondering if there is any information on institutions that went from an IVT Team to strictly to  PICC team. We currently do all the IV starts, restarts, blood administ. , skin test, and PICC insertions. We would like to make a transitions to strictly PICC team. Any info. or contact info would be greatly appreciated.
lynncrni
My advise would be that this

My advise would be that this is the wrong direction for the safety of patients. The CDC has long placed the highest rating on their recommendation for a dedicated group of nurses to insert and care for catheters. They did not call out only PICC insertions. I would advise to restructure your team some other way. Also give the skin test back to the primary care nurses. Vascular access and infusion therapy can NOT be separated. 

 

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

daylily
Our IV team is in the

Our IV team is in the process of transitioning roles.  We had the same responsibilities as you, in addition accessed all types of catheters, daily blood draws and supported the oncology nurses by hanging chemotherapy.

We were unable to get the PICCs done in a timely manner and many were being sent to IR because we physically could not do it.  For years we struggled with training staff nurses to start PIV but they never maintained the skill.

This past summer we started preparing for the CMS changes and developed a CR-BSI sub-committee.  Through varies meetings and discussions along with a new Director of Patient Services we are transitioning the responsibilities of the floor nurses. 

They are now hanging their own blood products.  They are doing basic IV starts and calling our team for more advanced needs. 

We have purchased a second ultrasound machine and have started an early assessment program (new last week still working out kinks) and are checking every central line every day on all patients.

The CNO told all directors that the IV team should be called when all other resources have been exhausted.  This was heard by all and we are seeing changes.

So we are not a PICC team we are vascular access specialists.

picween
Lynn, I totally agree.  I

Lynn, I totally agree.  I am currently in a health system that has downsized its IV Team in one facility , let go totally of another and has maintained the IV/PICC Team in the other facility.  Does anyone know of any recent literature out there that gives solid evidence that IV Teams are essential in keeping infection rates lower?  I have a pack that I recieved several years ago from INS, but the articles are from the late 90's.

lme PICC Team Clinical Leader

Is anyone having trouble with the Microclave?

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

It is a matter of economics and we are going into a very tough time.  I.V. Teams are once again being disbanded.  PICC lines are not a procedure that is done by the bedside nurse so it does require advanced skill and training.  Bedside RN's are capable of venipuncture regardless of their skill leve.  A CEO is going to look at job duties and labor hours.  Being a financial guru myself you can imagine if I had to make layoffs in nursing I.V. Team would likely come to mind and PICC team would not.  Unless of course I were to get rid of my PICC Team in lieu of an independent contractor.  Bottom line is you need to be able to financially defend your case/outcomes regardless of how you are structured and prove that you revenue save what you at least cost the system.  Start learning the math.  I suggest the achievement of outcome monitoring financially.  I know of very few teams that actually outcome monitor and know what their catheter dwell days are or their infection rate.  If you do not know your infection rate how do you prove your performance is superior.  That rate should be zero today.

Kathy

Kathy Kokotis

Bard Access Systems

kmills
We have had dedicated IV

We have had dedicated IV Teams at my Health System since the early 90's. The teams have been placing PICC lines for nearly a decade and use US guidance for placement. I am proud to say that they have maintained a zero infection rate for any PICC placed by the IV Team over these many years. This fact alone in a time of such strict CMS payment restrictions substantiates the continuing need for our IV Therapy Nurses. It is also important to recognize the recommendation of the CDC that Healthcare Institutions should have a team of nurses dedicated to vascular access. The Team also provides peripheral access and line draws as needed. I feel in this economy it is wise to make yourself as flexible and multifaceted as possible.

K.Mills, RN

Western Maryland Health System

James M Joseph
James M. Joseph RN , BSN,

James M. Joseph RN , BSN, CRNI

 

Lynn, Can you speak more about the importance of a dedicated IV team? What would this intail in your opinion? What would the job duties include and what would the availability of such a team be?

James M. Joseph MPH, RN , BSN, CRNI, VA-BC

 

lynncrni
INS offers a complete book

INS offers a complete book on this topic so I could not do it justice in a few sentences here. Basically, the infusion teams do not follow one structure that works for all hospitals. There can be much variation in what they do. However, I do know that most hospitals in the US have ignored the intellectual capitol required to provide safe infusion therapy for far too long. The scope of infusion nursing is defined in the Infusion Nursing Standards of Practice so more info is found in that document. In my experience, this is a 24/7/365 service. 

 

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

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

It is survival of the fittest.  If you are sending PICC lines to IR you will not survive this economic crisis.  I disagree with Lynn on this principle.  This is the worst economic time I have seen in my lifetime and it is worse than the 1980's this time.  It is about productivity and doing 3-5 peripherals prior to a PICC line in not excusable just because you have good IV skills and have a peripheral IV team.  I would re-align my duties to make early assessment a priority.  It is about PICC lines that is it is about recognizing the patient that needs a PICC line in the first 48 hours of therapy.  Reduction of CR-BSI has nothing to do with maintaing PIV insertions at all.  It has to do with getting rid of femoral lines, checking for blood return, making dis-infecting of ports at point of service accessible, and checking dressings.  PIV's do nothing to reduce infection or maintain lines.  Who really knows what the real PIV infection rate is as they hardly have dwell time so once the bacteria is sent up the system how do you track it to one of the multiple PIV's that a patient had.  Big hospitals are moving forward and getting out of the PIV service.   Staff RN's are allowed ahd can do PIV's.  It is about early assessment not the ability to get multiple PIV's in with one attempt.

Kathy Kokotis

Bard Access Systems

KarenRN
Having experienced a
Having experienced a down-sizing of the IV Team several years ago, our administration is committed to maintaining our team, a combination of all infusion access services. In past downsizing, patient dissatisfaction w/ multiple IV pokes tripled! Since re-instating the IV Team and PICC placement/maintenance, our infection rate is zero for all PICCs, nearly zero for all other central lines. We do all PICC drsg changes and some central line changes. Specialy areas handle their own drsg changes after competency verified through us. Pt satisfaction is above benchmark, which also correlates to increasing market share. Specialty areas (ED, L&D, pre-op, and others) manage their own PIV starts and call us for challenging ones. Med/Surg staff do not have the time or maintain the competency to manage PIV, since they are also held accountable to pt satisfaction rates and reduced LOS. Our team has assisted in reducing LOS (another cost savings) by identifying patients who would benefit from early PICC placement; transfers / discharges do not have to wait on PICC.
lynncrni
Thank you so much for your

Thank you so much for your post. It is abundantly clear to me that Kathy Kokotis does not understand what I mean when I say a full service infusion team. I do not mean a stick and run team doing nothing but placing PIVs. I mean a team that focuses on all aspects of infusion therapy. I believe it is also abundantly clear that hospitals have not made the necessary investment into the human capitol needed for safe and effective infusion therapy. The skill to insert a PICC is just not sufficient. So teams that do nothing but insert lines without doing a complete nursing assessment of your patients are not meeting the needs. Infusion therapy and vascular access can not be separated. All we have to do is look at published outcomes - intravenous medications errors have the highest rates; blood incompatibility is on the list of events that CMS will no longer pay for; CRBSI will reach zero ONLY when we pay careful attention to all aspects of the entire system and not just catheter insertion. Ok, I will get off my soapbox now.   

 

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

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