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2 RN PICC placement

At my full time job we place PICC lines using one RN to place the PICC and one to circulate during the procedure, at my previous job, we did this the same way.  I have recently started a 2nd job at a small (74 BED) hospital and they do not place very many PICC's monthly, maybe 20, when they place a PICC, they use a two nurse procedure, but the procedure consists of one nurse setting up the sterile field, using the ultrasound to access the vein, stablizing it, placing the dialator in the arm, THEN, the second RN takes over and places the catheter.  I have NEVER seen anything like this and when I asked what the rationale behind this is, I was told that since they dont place that many PICC's, it helps to keep the skills up for both RN's......... I am unfamiliar with this and frankly, very uncomfortable with it.  I certainly do not want to work off of another RN's sterile field, if I did not set it up, I cannot guarentee the integrity of it, nor do I want to place a PICC in a vein that I did not decide on myself.  Has anyone heard of this, do you do this in your practice.  I have the INS evidence based book with me and the only thing I can find is a small blurb that states

"When two nurses are working simultaneously at the bedside, the second nurse can be setting up supplies on the sterile field, providing support for the patient, and assisting when needed to access the vein, insert the wire, or thread the catheter."

Does anyone know where I can find evidence supporting this either way?  I cant imagine this is best practice, I would really like to know.



Cherokee people
2 RN PICC placement

Do you collect data on site infections and/or your CLABSI rates? I would be curious to know what they are. This would be something you could bring up. I would take my concerns to my director. I agree with you. I would not want another nurse to take over my insertion and vise versa. I think that there would be a high risk of breaking sterile technique with this practice. Would it not be best to alternate nurses to keep up there skills? I teach for a vascular access company and I teach when 2 RN's are placing a PICC one nurse is the inserter and the other sets up, does the paper work, etc. I don't know of anything out there that would help you prove this though.

Did you actually see

Did you actually see this?  If they are doing what you said then your  "blurb" describes exactly what they are doing and perfectly acceptable.  

One could view this like in the operating room.  You have circulator and crew that set up the sterile field and the physician comes in and uses the setup.  This is accepted practice in the OR where stringent standards are in place.  Maybe the physicians should come in and say they cannot operate since they did not set up the sterile field.

What is their CLABSI rate?  Do they follow the central line bundle? Was there a break in sterile technique?  Was there gross neglience?  When standards state as you said "When two nurses are working simultaneously aat the bedside,  the second nurse can be setting up supplies on the sterile field, providing support for the patient, and assisting when needed to access the vein, insert the wire or thread the catheter."  Does their team work outside this statement which you posed?  It sounds like this team does things different but all inserters do things a little bit different.  Who is right and who is wrong? 

The reason two nurses are

The reason two nurses are required as stated in the national patient safaty goals is that the "circulating nurse" observes for breaks in sterile technique, and can assist the patient during the placement procedure and also be available for getting additional supplies if needed once the placment procedure has begun. To keep up skills why can't your institution simply allow for the PICC nurses to take turns in inserting and circulating for every other patient-not switch roles mid procedure.

From the way that you

From the way that you describe this 2 inserter technique, it sounds as though this is done on a regular basis. Does that mean that only the vein-accessors have ultrasound skills? Not the PICC-threaders? What does the vein-accessor do when the PICC-threader takes over? To me, this sounds very strange and completely unnecessary. We use two RNs but one places the PICC and the other circulates, period. Then, next PICC, we switch. If the inserter runs into problems, say, accessing the vein, he or she may request the circulating nurse to step in briefly to help then the initial inserter takes over again. ALL our nurses have ultrasound skills and are able to insert PICCs independently. If the patient gets an insertion-related infection, who is liable? Frankly, I wouldn't place PICCs under those conditions. You know what they say about too many cooks spoiling the broth. Why have four hands involved in a PICC placement when two are sufficient?

sue verbella
2 RNs placing PICCs

It was stated that two RNS for PICC placement according to the National Patient Safety Goals. Can you direct me to where this is actually stated in the goals.

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