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2009 National Patient Safety Goals

One of the 2009 national patient safety goals is to improve the accuracy of patient identification. Under this topic I was interested in learning how various teams perform their time-out for PICC line insertion procedures.

Also, I was interested in learning how various teams identify their PICC line insertion site. Do you mark the site with a divot, surgical marker, ultrasound, etc. ? 



Michelle Crum

rivka livni
Inserting RN and another

Inserting RN and another person do a verbal positive ID with the patient asking him to tell us his name and BD. If the patient is unable to speak we do a verbal positive ID using the medical arm band.

PICC arm is not marked but is rather decided based on medical history and after I evaluate venous images by Ultrasound, including the patency and imaging of the IJ on the same side. No marking is necessary, once the arm is selected, the exact insertion site will be chosen at the start of the procedure when I image the veins up and down from AC to Axila and make a decision where the best entry point should be.



We usually have two people

We usually have two people verifying armband -- name, account number or medical record number, and birthdate.


Regarding the UP (Universal Protocol)  -- there was discussion recently about PICC lines being covered under the UP and one of our nursing administrators sent some questions to JCAHO.  This is what they said:


Q -- For peripherally inserted central catheters (PICC) inserted at the bedside by a nurse, would the site need to be marked if the nurse was using bedside ultrasound equipment to determine which vein to access? The nurse does not know which "site" will be accessed until identified by ultrasound.

A -- No, as the site is not predetermined for the PICC insertion if the nurse is using ultrasound to guide the choice of vein.

Q -- Do all procedural patients have to be "marked" in some way? Or just those defined by the Joint Commission as stated in the revised UP?

A -- All procedures as defined in the FAQ copied below would require site marking when there is laterality, level or a specific digit involved. Q. What procedures fall within the scope of the Universal Protocol? A. The Protocol is not limited to operating rooms; it is relevant to all settings where procedures are performed. The Protocol and its implementation guidelines apply to all operative and other invasive procedures that expose patients to more than minimal risk. The Joint Commission's glossary defines invasive procedures as involving "the puncture or incision of the skin, insertion of an instrument, or insertion of foreign material into the body. Invasive procedures may be performed for diagnostic or treatment-related purposes." While The Joint Commission does not specifically define the term minimal risk, certain routine "minor" procedures such as venipuncture, peripheral intravenous line placement, insertion of a naso-gastric tube or urinary bladder catheter are not within the scope of the Protocol. However, examples of procedures such as PICC line and all central line insertion, chest tube insertion and other similar types of common procedures are included. Please note that procedures specifically excluded from the Universal Protocol are electroconvulsive therapy (ECT), closed reduction, radiation oncology, lithotripsy and performance of dialysis (excluding insertion of dialysis catheters). The overall purpose of the Universal Protocol is to improve patient safety and prevent procedural errors. Based upon the statements of the preceding paragraphs, and with a focus on safety, each organization is expected to clearly define for itself which procedures will fall within the Protocol. All healthcare workers involved in operative and other invasive procedures should know for which procedures the Protocol must be utilized.

Gwen Irwin
We do the time out with 1
We do the time out with 1 PICC RN and chart that we used 2 patient identifiers.  We do not mark anything.
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