We place a little over 100 PICC's/month. About 8 to 12 of these are outpatient.
Our docs wrote "guidelines"(JCAHO driven?)regarding outpatient procedures. One
of these was that any outpatient receiving an invasive procedure-including central
lines, had to have a recent-(within 30days with an update within 7 days-History and Physical.)
 Now they are unhappy they have to write H&P's when they send patients in for
PICC Placement because we insist on a recent H & P. The latest thing they've done
to get around that is to state that PICC placement is not an invasive procedure and
therefore doesn't require an H & P. The nurse who keeps us all adhering to JCAHO
(I'm not sure of her title)now says that if it is not an invasive procedure, we don't
need to get a written informed consent for it...not for inpatients or outpatients.
 I know the docs in our hospital have a lot of power, but am apalled to think they may
be able to decide unilaterally what is and what isn't an Invasive Procedure.!
 Has anyone heard of anything like this before? Are you all required to get some kind
of informed signed consent?   Where does this put our PICC nurses from a legal standpoint?
Tanya
Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.
[quote=anna liang]Our QI called JCAHO last year, and was told that PICC was considered invasive procedure[/quote]
Anna, thank you(and thank all of you)for your responses. I wrote an e-mail
to JCAHO at their web site, asking if JCAHO considers PICC placement an
invasive procedure...have not heard back from them yet.
This issue has become very hot here at our hospital...I'll let the forum
know the outcome.
Tanya
T. Nauman RN, CRNI
Well, let's think about this. You are making a puncture into a deep vein in the upper arm, located near nerves and arteries that ensure the function of the entire extremity. Then you are advancing a rather long catheter from this location to the SVC. Yep, that is invasive to me! With that being said, there are some facilities that have included PICC insertion procedures under the general consent that the patient/family signed upon admission and do not require a separate signed form.
Also, a signed form is just one small component of informed consent. So you are still required to educate and obtain the verbal consent of the patient even though a signed paper may not be required. 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