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ipadonai
Cut off time for PICC consults in a hospital

We are two RN's on a Vascular team for 298 bed hospital.  Two nurses work Monday through Friday placing PICC lines and difficult IV's. We stay late occasionaly until 6-8 PM if needed.

Our Administration informed us that we should not have a cut-off time for PICC consults. Our hospital does not have an IV Team providing 24/7 coverage.

We would like to know from the group if your hospital has a certain cut-off time for PICC consults and what is that time?

 

Thank you,

 

Inna Perfido, RN, BSN

Charleston, SC

Angela Lee
It is unrealistic to think
It is unrealistic to think that you can place PICCs until late in the day with 2 FTEs that are day shift.  If I am very busy I have to set a limit on what I can do.  I will let staff know that the patient will be seen the next day and if access is an issue he will have to be supported with a PIV until then. I an salaried so don't get overtime but still stay late often just to keep up.  If administration wants no cut-off time for PICCs then they need to provide more staff.  The staff here generally knows that if a PICC is ordered after 2 or 3 in the afternoon then it will not be done until the next day.  I work in peds and it can be very time-consuming to place a PICC.
gretchen
I work Mon-Fri, 0800-1630,

I work Mon-Fri, 0800-1630, inserting pediatric PICCs.  I tell the doctors that I will not start a PICC procedure after 1500 (time enough to allow for placement and confirmation for last line placed).  There is only one of me, and occasionally I will stay late to place lines, but that should not be expected...  I am hourly, so I get the overtime on my check. 

If the Docs order a line too late in the afternoon, I tell them it will be done the following day. 

Hope this helps

Gretchen

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

With 2 FTE's is it impossible to do eary assessment so if the doctor orders a PICC at dishcharge or after venous exhaustion that is their fault.  I suggest doing a review prospectively of patients on date of admit, date of PICC order, date of PICC placement and date of discharge to identify on which date the PICC patient is identified after admit.  Sounds like reactive therapy to me 

 

Kathy Kokotis

Bard Access Systems

pjean
We too are M-F, 2 person
We too are M-F, 2 person team for 400 bed hospital, PICCs and difficult IV services from 0700 until 1730 each day.  We are hourly, so we do get OT and we do stay later when necessary.  We follow the philosophy that PICCs are not Stat and so if we get a consult after 1530, it usually is scheduled for a.m. next day.  We do try to make sure that our patient has access for the interim, so we usually start a peripheral IV to get them through until we do their PICC.  We lose our in-house radiologists every day around 1800 (sometimes 1900) at which point the x-ray has to be "Rad-linxed" which adds way too much time to insertion and makes late cases even longer.  Hope this helps.
vicpenrn
I'm so glad to see that we
I'm so glad to see that we are not the only hospital with this issue. We currently have 2 FTE 0700-1500 M-F, and I work 0700-1900 S & S (alone). We are training another RN at this time, so there will soon be coverage from 0700-1900 everyday. We currently insert line until 1400 M-F and 1600 on week-ends (the xray are sent through PACS to be read after that time of day). It can take anywhere from 1-3 hours for us to get results. We have had several meeting with our manager (she covers many other departments in the hospital) about this same issue. I now have some information from other hospital to share with her.
cathie
we have 2 FT picc nurses for
we have 2 FT picc nurses for a 600 bed hospital...we stagger our hours, 8-6 and 10-7..the overlap helps bring sanity to the day...we place an average 10/day and daily over time..we try to cut off at 5, but leaving lines for the next day only creates additional burden to the AM consults
cathie
we have 2 FTE's for a 600
we have 2 FTE's for a 600 bed hospital...we stagger our hours..8-5 and 10-7 we are always in overtime. which is frowned upon,..but this schedule helps get the piccs from the previous evening done, and the late person can follow-up on the lines...we average 10/day
Dianne Sim RN VA-BC
 It is my opinion that PICC

 It is my opinion that PICC placement should be available in acute settings 24/7. If a facility can make sure there is a physician available 24/7 to place a more risky CVC, surely the facility should be responding to all the studies indicating that PICC placement by a Vascular Access RN is less risky (and hence less expensive in $ and patient trauma) and ensure that there is 24/7 PICC coverage. I also think that there is such a thing as a "STAT" PICC !

You can obtain this coverage by employing per diem Vascular Access consultant(s), or contracting with Vascular Access companies (such as mine) who are available 24/7, including those times when your PICC team is overwhelmed (due to vacations, sick leave, excessive number of referrals during the day, delaying commencement of therapy or discharge of a patient)

Dianne Sim RN

CEO & President,

IV Assist, Inc

Dianne Sim RN, VA-BC, CEO; IV Assist, Inc.

Nina Elledge
So, if your hospital says

So, if your hospital says there shouldn't be a cut-off time for PICC referrals, are they going to be increasing your FTEs? There's no way they can expect you guys to work a hospital that large day after day and do the overtime that's going to be required to cover their additional "requirements". You guys are going to burn out faster than fast.

Are you able to show them numbers of how many PICCs you place during your shift, let them know what ISN"T getting done because you do nothing but lines, and such?

My hospital has a 24/7 service for 260 beds, 3 RNs on Days, 3 on Evenings, 1 on nites. The nite person is getting paid to do hardly anything. It has been this way for 5 years. There is rarely a PICC after 11PM, because patients don't want to do this in the middle of the nite (our ICU usually has residents who need to get their non-tunneled line insertion skills done, so PICCs aren't usually the first choice there unfortunately).

I don't think hospitals need a 24/7 service for PICC insertions.

Just my 2 cents

 

 

Nina Elledge, RN, MBA, CRNI

[email protected]

Heather Nichols
  We are a 450 bed level

  We are a 450 bed level one trauma facility.  There are a total of 4 fte's and one PRN that works 2-3 days a month.  We usually have two PICC nurses on per day and we do 12 hr shifts 8a to 8p.  We did a year long study of night shift PICC orders and found there were not enough, and being that a PICC should NEVER be a stat procedure, we decided to do away with our night shift.  We trained a few key nurses on night shift to use the ultrasound for difficult peripherals and they have become quite profficient.  We get our orders thru the nite, and start on them first thing in the am.  We will not usually start a PICC after 6pm, but that is not policy.  It's more an unwritten rule since the ones you do late ALWAYS end up being the difficult ones that keep you overtime.  They do the strangest things after 6pm......

   Anyway, some of the facilities in our area have out sourced their PICC's to Vascular Access companies, especially to cover night shifts.  We do a whole lot more here at U of L than place PICC's though. We are a Vascular Access team of specialist, and when we get a PICC order, we consult on that patient to decide just what kind of access that patient needs.  We do not always place a PICC, but when we do we follow our PICC's daily and collect data on every aspect of them.  An outside company can not do that, so I worry about care and maintenence of the lines these PICC companies place.  I am not saying that the companies do not do a good job PLACING the PICC's.  They just do not follow them, and if the floor nurses are keeping these lines cared for, well lets just say that most everyone in the PICC field would know that that is not a very good scenario.  A specialty team is ALWAYS the best team.  There are too many studies to prove that already.  

  Good luck though.  Do not burn youself out.  I love placing PICC's, but I am just getting too old for all that overtime.

Heather 

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