Hello all.
I am wondering how any other facilities "manage" their picc lines. We are a 600+ bed hospital. We place 150-200 Picc's a month. We leave our Piccs with a biopatch, statlock and tegaderm dressing. After that the nurses have policies and supplies to deal with any issues from clots to dressing changes. We are available for consultation but basically we Picc and run!
I have a few issues with this. Our facility tracks CRBI's and if one occurs, of course all eyes are on us. However, we feel like, "I put that in a month ago and heaven knows what has happened since".
What are other facilities doing? We would obviously have to address our staffing to manage dressing changes and troubleshooting.
Thanks!
Martha
You have identified the exact problem with those teams and contracted services that ONLY insert PICCs. At the Decennial Conference on HAIs last week, I heard several people from the floor ask questions and report that the disbanding or severe cutbacks in full service infusion therapy teams resulted in more PICC usage because of the lack of high level skills for difficult venipuncture. Many of these patients did not need a PICC, just someone with good venipuncture skills. This increase in PICC use was also increasing CRBSI and one even said he had mandated that no PICCs be used! Of course this is counter-intuitive. I share your concern about abandoming the care of the PICC to the primary care staff nurses who have had everything else dumped on them without enough education. After the first week of dwell time, there is more biofilm on the internal lumen surfaces and this is probably the source of the majority of those infections. This is directly related to the needleless connector use, lack of adequate cleaning before use, and use of contaminated tubing for intermittent infusions. This requires an infusion nurse specialist, not just a PICC inserter, to serve as educator, consultant, resource, advisors, etc. I do not mean to insult those that consider themselves to be "PICC nurses", but I do have a huge issue with this approach. Lynn
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
We are also have what I think may be a unique team structure. Our hospital has an IV Team but the PICC nurses are not part of that team. Not even the same department. We are based out of a procedural sedation department. We are more like the central line nurses.....and keepers of the site-rite. We assist with inpatient and outpatient procedures, mostly vascular access and cardiac procedures.
How are other hospitals structured?
Martha
Lynn,
Our deparment is fortunate enough to have a nurse that has been there 35+ yrs. She has seen it all. For a while in the late 90's and early 00's our facillity did away with IV Team. The number of PICC's skyrocketed. A few years ago the IV Team was brought back and as you can guess, we do a lot fewer PICC insertions. We do find that often what is needed is not central access but as you said, a skilled hand. Frequently after we ask a few questions we discover that what is really needed is the ultrasound for the iv insert. We often have small arguments about IV vs PICC. Noone from nurses to Dr's seems to realize that PICC's are not risk free and if a patient is ok with a peripheral iv then a PICC is not worth the risks or costs.
Martha
We are a small rural hospital of 101 beds, and I place about 40 piccs per months. I am the "PICC team". I recieve the consults, review the chart, assess the patient, discuss with MD any concerns or issues , educate and inform the pt and then if it is appropriate insert the picc line. ( many times, I have just ended up inserting a peripheral line, or even finding out they have a port and acessing that ). Once I put iin the PICC line I do a 24 hour post insertion assessment, weekly dressing changes, I change all the caps every M-W-F , and do all the trouble shooting. We tried it where I just put in the PICC lines and left iit to the floor nurses, even ICU nurses to manage the dressing, cap changes etc. and it was a mess. We did educating , training, hand on teaching etc.. but they still didnt manage those lines up to my satisfaction and I had serious concerns about blood stream infections, catheter damage and line patency.
Since I am seeing patients at least 3 times a week if not more I am able to keep a good look and hand on all my lines. When I go in the rooms and see tubings from intermittent lines hanging with no caps I discard them and then tell the nurse what I did and why. When I see a nurse accessing the line without washing hands, putting on gloves or scrubbing the hub I take that time to go over it with them. It works out great this way. They definitely have a "hands off approach" and prefer to let me handle all issues. ( this sometimes can be bad ) They call me quickly, most of the time, for issues of patency, or the dressing doesnt look right.
I do frequent education via emails, one on one, new employees, and annual competencies. I felt the same way you mentioned above. If you just put the picc line in and then let someone else manage it , things are not done correctly and this reflects poorly on picc lines success and outcomes in your facility not to mention the increase in patient mortality with BSI.
Thanks, Gina Ward R.N., CPAN
Gina Ward R.N., VA-BC