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Robbin George
The cost of a bedside PICC adjustment
If we place 1100 PICCs /year (avg 90/mth--22/week) and the national avg bedside adjustment rated is 10%=110 adjustments per year (2-3 PICCs/week require bedside adjustment)--What is the cost of a bedside PICC adjustment (Including supplies time added CXR and intangibles) that would highlight the benefits of the added cost of purchasing a tip locating device--I am trying to justify the cost in next year's budget--Thank you in advance  
Don't think it's possible to
Don't think it's possible to justify from a cost perspective. Also take into perspective how many are repositioned due being at the atrial/caval jxn, and the physician wants it pulled back. As far as I am aware the current group of tip location devices  are not able to eliminate this. Also are those that are repositioned due to the radiologist stating they don't like the angle of the line in the SVC and would like it pulled back a cm. The jugular can typically be ruled out with the u/s as well.
In 2006, I gathered data to

In 2006, I gathered data to present to value analysis in support of purchasing a tip location device.  Ultrasound usually works quite well to r/o IJ tips, but not always.  It also will not help you catch contralateral malpositions. We've actually also been able to suspect azygous placements with accuracy now that we're familiar with how our TLS works, and will consider pulling back and readvancing when we get certain information from the device.

Our Value Analysis team took the information I provided seriously, and it was largely responsible for the fact that we do now have a tip location device.  Here's our info for one year (2006) in a distilled format, looking at those PICCs we had to reposition after initial films:

 Dressing change kits $   798.38

 Chest xrays $15958.80

 Prof. Rad'ist reading $  4092.00

 IR repositions $22209.00 (some of these may not have been avoided by TLS, but it was still valuable information for the value analysis team)

 IV RN repos (1 hr) $  6479.00 


TOTAL: $49537.18

Then add:

Delay of treatment time (may not get TPN until next day, lost cost of TPN already prepared, delay of treatment can be up to 3-6 hours, delays from transport being backed up, from radiologists not providing readings in timely fashion - unless you're doing your own tip determinations), length of stay increases (delay of discharge, etc.).....

and THEN add opportunity cost:  We could have placed 139 PICCs in the 209 hours it took to reposition, which was a potential revenue loss of $203,079.  From a microeconomic/accounting perspective this figure is understandably soft, but I think makes a point and is worth mentioning. 

 and THEN!  add the patients who might have needed other vascular access attention that they weren't receiving because your staff were doing repositions.  Cases of phlebitis/infiltration/extravasation that staff RNs weren't attending to properly, other co-morbidities from poor vascular assessment.....this may seem like a stretch, but it's real (in a large teaching facility, this is an unfortunate reality).

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

mary ann ferrannini
We did not have to pay for

We did not have to pay for our TLS b/c we agreed to purchase x amount of PICCs per year for a set time. The number was low in comparison to what we were actually placing. You may also be able to get a discounted rate or 2 for the price of one deal if you have a sister hospital also interested. Have you checked this out. We LOVE ours!!!!


Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Christine Naylor - JAVA Vol 12 No 1 2007

Reduction of malposition of PICC with tip location system

cost analysis was in this article.  Hope that helps


Kathy Kokotis

Bard Access Systems

I agree with above.  Susan
I agree with above.  Susan
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