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Consents-Is PICC placement an "invasive procedure"?

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?


Kristin Walker
I also have some concerns
I also have some concerns in regards to obtaining a signed consent for Picc Placement.  Our institution currently regards insertions of Picc's to be an "invasive" procedure and it does require a signed consent and official documentation that a "time out" was done prior to the procedure.  If we are unable to obtain a consent for what ever the reason (ie., pt obtunded, family not available), then we document that and proceed.  I have talked to several people on this issue and found out some hospitals do not require a signed consent with the rationale that only a MD can do consents however they still do pt teaching and document that in the chart.  Any official ruling on this requirement would be greatly appreciated!

Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.

Have you asked your risk
Have you asked your risk manaer about this?  Try providing the risk manager the INS Standards and Policy & Procedures.  Correc me if I'm wrong but the institution can be held liable if the P & P are not current with the prvailing standards.  You may be alright but I think you could have a problem also for not following the standards as a prudent nurse should.
anna liang
Our QI called JCAHO last
Our QI called JCAHO last year, and was told that PICC was considered invasive procedure
[quote=anna liang]Our QI

[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.


T. Nauman RN, CRNI

Well, let's think about

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, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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