Forum topic

I have always worked on teams that are dedicated to only infusion therapy which included PICC insertion. Since 1989, I have been giving PICC insertion courses and a few years ago, I made the policy that I will refuse to provide this course to any hospital that did not take the dedicated team approach. After numerous courses in the same hospitals, I have seen this idea of having generalist or primary care nurses placing PICCs to faill over and over again. It simply does not work. Your outcomes are never as good as if you have a specialist doing this all the time. I don't do PICC insertion courses any longer because others are meeting the needs but would still stick to this policy if I was. 

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

www.hadawayassociates.com

I am a one woman show.  I manage all aspects of PICC placement and care. This instution used to have 3-4 staff nurses who also placed PICC's when they were here if they had the time.  Obviously this process was not effecient and IR was placing most PICC's which they clearly did not enjoy.  We are about a 250 BED facility.

Libbi

I work for a smaller (approx 200 beds) hospital.  We have dedicated PICC nurses here at our hospital.  There are only 2 of us and we mostly work alone, unless we have many requests in a single day we will call whoever is off in.  We currently work 7 on 7 off and provide the PICC insertions as well as all PICC maintenance.  We place anywhere from 70-90 PICC lines per month.  We are hoping as time goes on that our team may grow. 

Beth

PICC team members/IV team members ONLY do PICC or IV insertions.  They also provide education and consults.  

Staff RNs do not place PICCs.

I would never recommend that it be otherwise.  Vascular access as higher or high risk procedure requires frequency, excellent vascular assessment and critical thinking skills, and regular standardized competency assessment.

It is not reasonable, nor safe, to expect a PICC RN to perform other bedside tasks.  Nor is it reasonable, and definitely not safe, to have a staff RN with intermittent practice of these skills place PICC lines.

Mari Cordes, BS RN 

We are a 3 person dedicated PICC team covering 2 hospitals, with a total capacity of about 250-300 beds. We maintain all central lines also. We also will help out with difficult IV starts if time and workload allows. That keeps us quite busy. No one else places PICC's.

We have a core group of nurses who now work out of an outpatient treatment center. We have 1 PICC RN available 12 hrs daily. We place about 150-160 lines/ month. Often we are busy each day just with insertions & dressing changes, but we can help out in the treament center if we are slow. In years past we did PICC's as a side duty out of the O.R. (anesthesia asst. nurses) and it got very difficult to juggle the roles as demand increased for PICC lines. At that time we also had a few nurses in oncology who could place PICC's (pre-ultrasound)- and it was difficult for them to be taken from patient care to stop & do a PICC. I know it's tempting to want to cross-train thinking it's so much more efficient use of FTE's- but it sure does work better to have specialty people doing the task. If you want zero CRBSI's do you want people who place 1 or 2 a month as a sideline doing it?

Paula Happel, RN, MSN

Mercy Medical, Cedar Rapids, IA

We cover over 700 beds in a 5 hospital system.  We place over300/month.  We do travel from site to site. We have 8 PICC competent nurses.

We gave up a very long time ago on having prn's do PICCs (probably 2002).  They couldn't keep up with competency at all.  We also gave up on vendor PICC classes (probably 2002).  The outcome of vendor classes were very low percentage of PICC nurse comptence.

Gwen Irwin

Austin, Texas

Our PICC program is centralized at our facility of over 900 beds.  We place approximately 350 PICC's per month.  The PICC team has 14 RN's trained in ultrasound guided PICC insertions.  We also have a relationship with our Interventional Radiology colleagues and a process that the PICC team must refer any patient to IR to be sure that they have been evaluated by us first, and then keeps the patient on our radar.  We assess all inpatients with PICC lines on a daily basis, do all of the PICC dressings and are solely responsible for managing occluded PICC lines.  Historically there have been attempts, particularly by different medical residents to have them trained in PICC insertions.  These programs have failed miserably as the residents do not have the time or the number of insertions to maintain competency.  Furthermore, the de-centralization of the PICC program proved to have less than desirable patient outcomes.

Hope this helps.

 Janet Mulligan, RN, MS

Nursing Director ~ IV Therapy

Massachusetts General Hospital

Boston, MA

We have a 250 bed commuity hospital. 2.5 FTE dedicated to PICCs. We round on all patients with dwelling PICCs and review the admission and pharmacy report. We place 120 PICCs, 30 midlines, and approx 30 "hard" PIV monthly. If we place an outpatient PICC line and a first dose of meds is ordered, the nurses in the special care unit are responsible for administering the med. The staff nurses do all routine PIV starts and the dressing changes and blood draws on all CVC including PICCs.

Good luck

We are a 4 person (2 fulltime, 2 halftime) PICC/IV team. We are the only ones that place PICCs. We also do all of the dressing changes. The ICU nurses would like to be able to place PICC. I am not sure that there would be enough of them to keep current and competent with their skills. We place between 2-6 PICCs per day.

PRN people worry me in the fact that they aren't placing enough to stay competent.

we are a private iv company and we ravel all ovr MA keeping thins very  busy

We are a 300 bed hospital.  We have a team of 4 RN's that work in Radiology assisting with moderate/deep sedations for all ages of patients during invasive procedures.  We also assist with deep sedations in Pedi ICU for short term therapeutic/diagnostic procedures.  We are the staff that provides the PICC line insertions for predominately adult patients although the request for pediatric PICCs are increasing.  We have taken the pediatric PICC line coarse and have been observed by the Pediatric Intensivists to check us off.  Our average PICCs per month are 60 and gradually increasing.  We also perform outpatient PICC lines.  We do not perform the dressing changes or declots on the lines.  We are currently asking management for an additional FTE to assist us with all the duties.

We are a small hospital ~250 beds.  We have a dedicated team of 4 RN's who place PICC lines (1 FT, 2 PRN, and 1 Weekend).  We do all of our own care and care for those that come in from the outside.  Being new to the PICC team (less than 1 year) I can't imagine just placing PICC's every once in a while.  This is such a specialized and complicated proceedure, and not a benign one at that.  I would not feel comfortable having someone place a line in me that was not well practiced with this proceedure.

We also run an Outpatient Infusion Clinic during the day.  We always have 2 RN's on except for the weekend when we have shorter hours for the clinic so that our weekend lady can get out to do PICC placements sooner after the clinic is done.  We also require our floor RN's to fill out an assessment form and have it to us by 1400 for same day placement. 

We are a 391 bed hospital (this number excludes pediatrics). We have an IV team of 8 per day. As an IV team we place all of the IVs in the facility including outpatient surgical areas and CT with the exception of ED and L&D. They place their own, however we back them up. 1 nurse is assigned to be the PICC nurse for the day and then one of the others will assist depending on which area the PICC is ordered. Unfortunately we only offer PICC service during the day shift. On evenings we drop down to 3 RN's and they will occasionally place a PICC. On nights we have only 1 RN. We are responsible for maintaining all PICCs as well as any CVC's that are in a non-ICU area.