Forum topic

9 posts / 0 new
Last post
Mary E Selby-Carloni
Anesthesiologist Placing PICC Lines
I have heard rumor that some IV teams are no longer placing PICC lines.  Anesthesia departments have started doing PICC lines in these facilities because they realized the profit potential for PICC placements.  Does anyone have any info on this trend?  Our radiology department stopped doing PICC lines because of the low reimbursement.
lynncrni
I have certainly not heard
I have certainly not heard of any anesthesia depts taking up the job of PICC insertions for the reason you mentioned - low reimbursement! In fact, I have heard of anesthesia dept moving away from inserting any CVC unless the patient is in the OR. Certainly the majority of PICC candidates would not be surgical patients. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Linda Lembo
Linda Lembo CRNI Valley

Linda Lembo CRNI

Valley Hospital

Ridgewood, New Jersey

Occasonally when the anesthesia department can not get a line we (the PICC  team) are called to place a line in the OR. It has never been mentioned to have them do the lines.

Linda Lembo CRNI

Valley Hospital

Ridgewood, New Jersey

Sue Witkowski
I have recently been
I have recently been approached by my director wanting to know how I felt about anesthesiologists placing PICC lines when the patient is in the OR for another procedure. I have some concerns and I would like some feedback from this group. I believe the thought process is faster placements.
lynncrni
Most anesthesiologists that

Most anesthesiologists that I have ever worked with do not like to use PICCs. Their length adds resistance to flow and they are afraid that they might not be able to get the rapid flow that they may need for some cases - a valid concern.  Also, a study several years ago showed that CVCs placed in the OR had greater rates of infection because the inserters were relying on the setting and not technique for all the safety procedures. I doubt that anesthesia will have the proper time to devote to PICC insertion as they are usually pushing cases through as fast as possible. 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

momdogz
Our anesthesiologists don't

Our anesthesiologists don't place PICC lines, but there are cases every once in a while where it is appropriate for us to place the PICC line in the OR when the patient is there for another (simple) procedure.  Usually these cases have to do with the need for sedation or complete general anesthesia.

When it's the right thing to do, we really like doing these cases - nice procedure room, plenty of staff to assist when needed, and...the patient's asleep.

But no - I don't think our anesthesiologists would be putting PICCs in for all of the reasons stated below.  We actually have begun training the resident anesthesiogists best practices in peripheral IV insertion (and slip in CVAD info while we're at it) - so I'm confident they'll leave the PICC lines to us. 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Leann Kennedy
Our policy at my facility is

Our policy at my facility is that if a PICC RN didn't insert the PICC line, we won't follow it.  We don't de-clot, d/c, troubleshoot, nada. The MD who inserted the line must be notified and troubleshoot. The reasoning is because I cannot guarantee that the same standards I follow are practiced by the MD.  This may seem a little harsh, but it works.   

momdogz
Sometimes you have to be

Sometimes you have to be "harsh"  - I like the way you use just consequences (MDs must do all follow ups on their lines).  Although, I wouldn't want most our our MDs doing catheter clearance or dressing changes, either!

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

gretchen
OH! I'm getting the

OH! I'm getting the sensation of a chalkboard with nails scratching it!!!!

THere are a couple of anesthesiologist who would LOVE to start PICCs in the O.R.  They ask about it nearly everytime I go to the O.R. to place a PICC in a child.  They want to know how, they stand over my shoulder, ask questions, they want to know all about the equipment, supplies, etc, etc.... even to the point of sending a tech up to my office to see what products I use.  They have asked, will you BRING a PICC tray down to the O.R. if I want to put one in?  (like I'm a supplies servant)  I told them (NO) if a child needs a PICC placed, I will be more than happy to come place it, as that is my job. 

I don't even know what education/competencies a physician would have to go through to be PICC competent?  I just happened to look up one of these anesthesiologist's credentials this morning, and they mention nothing about placing lines/vascular access. 

In regards to what Mari Cordes wrote, I told my boss that if it comes to the anesthesiologist placing PICCs, that I won't do follow up, trouble shooting, dressing changes, declotting, discontinuations, patient/family education, etc, etc, etc.  THere is SO much more to PICC Services than just accessing a vein.  I will tell the bedside nurse to call them if that ever comes to fruition. 

Here is an example of something that has already happened:  A few months ago, I was called by the PACU to discontinue a "PICC" line.  I happened to have been placing a PICC at that moment, and didn't even recognize the patient name (someone had answered my phone for me, if you're wondering).  The clinical coordinator went and D/C'd it, and told me it was a PICC catheter that had been placed in the femoral!  Definately not my work!  And who knows where the documentation is for it?!?!?!

To respond to the actual question, I think these guys in particular are not looking at profit, but wanting that warm, fuzzy feeling and sense of accomplishment they might get after successfully placing  a PICC!!!!! 

Log in or register to post comments