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How many vascular acess teams use two trained nurses to perform proceedure?

I would like to find out how many vascular access teams use two trained nurses to perform the PICC insertion proceedure. We have been working in pairs to help meet the new guidelines for monitoring sterile technique and are finding we are just as productive working together as apart. We also feel we improve patient safety working in pairs. Thanks for responding.

mary ann ferrannini
 We were doing this before

 We were doing this before and had to prove we were actually more productive this way. I did a time study for a month and it clearly showed that it saved a significant amt of time. That time study did not reflect our job satisfaction as we found that when we placed PICCs alone it was far more frustrating...IF anything went wrong it was more complicated to take remedial action and If I needed anything and could not get a nurses attention....I had to take my gown off and regarb....I really disliked it. I have always prefered to have another PICC nurse with me as I do not have to explain everything over and over again..I can just ask for the equipment I need and I get viable suggestions if we are having any challenges

VAT RN
We prefer 2 nurses because it

We prefer 2 nurses because it is just easier and faster. That said, we only have double coverage from 9-9. If we get too behind or have too many outpatients we have to fly solo. We do make it a big part of orientation, learning how to do it by yourself. It requires a special technique and more gloves. Lots more gloves. LOL. I always make sure the primary RN knows I am alone so if I have to put on the call light or call out for help she knows to come running.

If I wrote policy it would be 2 nurses but for us that is not always possible. We are also the Code Blue nurse, outpatient sedation nurse and scrub nurses for central line placement. That means we often  "divide and conquer".

Martha

Gina Ward
  When we started inserting

 

When we started inserting PICC lines it was myself and another RN who had trained with me.  We really needed eachother for tips, pinch hitting or getting more supplies and staying sterile .   Then......after a month or two I felt like we were wasting time. We even spoke to eachother and then our director about this.  We ended up just having one of us place and manage piccs fulltime.  We werer trying to juggle another job say pacu, or OP and then do piccs as a team when we had "free time"  this didnt work.   If I was not the inserter I felt like I was just distracting the patient, or trying to fill out other paper work ahead of time.  Iit is nice to have  2 nurses so you can get all the patients seen in advance, but for me when it comes to inserting the lines I am absolutely fine with doing it myself.    I usually try to place the nurse button under the drape where I know it is by the head or shoulder and can push it if I need help.  If it is a potential non cooperative pt this may be different and I may want help. 

Gina

Gina Ward R.N., VA-BC

bartina
2 PICC nurses

There are two of us on the IV Team. When we are both here toghether one inserts and one assists. We believe working as a duo cuts time and is great support. Some PICC insertions can be very challenging and there are times when we wonder, if the other team member hadn't been there, would we have been able to get the PICC in place? Since we have been using the Power PICCs we have had more difficulty advancing to proper position. Repositioning the patient, getting more flushes, even having one flush while the other twirls and advances have made a difference. 

I have heard from three other patients about experiences at other facilities where two and ever three nurses were working together on one PICC.

 

Nancy Rose 

Janine Pritchett
2 PICC nurses

Both our pediatric and adult teams utilize 2 nurses for placement.  As others have indicated, it saves time, feels more supportive and you have another set of eyes to help if there are issues.  Not having to explain which drawer and what color the item you need is very helpful as well.  For pediatrics, it can be very helpful to have someone who is very familiar with the procedure help with distraction, supporting the parent with distracting the child, etc.  For the adult team, when the procedure is finished and the inserter is documenting, the second nurse can go to the next PICC pt. and get consent, etc.  Good use of resources and does save time.

Janine Pritchett, RN-BC, BSN, VA-BC
Clinical Educator - Vascular Access

Carol Gosselin
picc insertions with 2 rn's

We have always done our picc insertions with 2 nurses. It saves time and when it is a difficult insertion their expertise is helpful. We all feel that having 2 nurses makes us more efficient. Our team covers 24/7 but do not place piccs on the night shift because only 1 nurse is on. This system has worked well for us. We are a 250 bed hospital with a 12 member IV team. We still do most of the peripheral starts and picc dgs along with picc insertions. we place 80-90 piccs per month.

Carol Gosselin

Miriam Hospital

Providence RI

Two person teams

Our service, at this point, only has 2 people who are full time. Therfore, we have to operate independantly. This however has been our profile even when we had 3 staff members. (We currently have a full time position available  HINT, HINT !) Does anyone know if the Joint Comssion is considering making a two person team a requirement ?

 

To Carol Gosselin @ Providence, I would like to discuss your team and operational profile. Your instituition is half the size of ours and you are placing twice as many PICCs. What are we doing differently ? Can you forward me your email address ? Thanks.

Dave Bruce RN

[email protected]

Albany NY

David Bruce RN

Carol Gosselin
2 person picc insertions

David

You can reach me at [email protected]

Carol G

Rhonda Wojtas
When we began we worked as a

When we began we worked as a team and it was great to have back up. Now that we are well trained we work independantly. There is only one of us on each day. If there is a difficult patient then I do have some one come in with me. I have become very efficient and can place a PICC under an hour. We do not routinely do PIV insertions and do not do dressing changes as I routinely placed 5-6 PICC's a day along with doing rounds to assess needs of the floors. I do remember when I started thinking I would never be able to do 4 PICC's in an 8 hour day. Now if I only do 4 it is a quite day.

I do agree there should be a second person in the room to make sure we keep a sterile feild it does not happen for me. If I even think I might have contaminated my gloved I change them. Until JACHO or someone puts it in writing that you have to have 2 people in the room, I don't see it happening at my facility.

Rhonda Wojtas, RN VA-BC

jlmulligan
We began our ultrasound

We began our ultrasound program with 2 PICC RN's for training purposes.  We now employ nursing assistants to be the assistant.  They are trained in sterile technique, gowning, gloving, masking, prepping the patient and being the monitor for all PICC insertions.  They stock the PICC carts, assist with the paperwork and database management and are cross-trained to assist the IV team with phlebotomy calls.  The program has been a great success.  Janet Muligan, MGH, Boston

kfritch
Janet, I would be interested

Janet, I would be interested in having a tech to support the PICC nurses. Do you have any info you would be willing to share that helped establish a program?

Thanks, Kathy Fritch

K Fritch, IV Therapy Charge Nurse

crobinson
2 nurses to place PICC's

We have also been using two nurses and find that it works well.   If there is only one nurse on nights he/she has to have another floor nurse or tech in with them to spot and do check list.

Kathy Evans
Our PICC team is staffed with

Our PICC team is staffed with 2 trained RN's per shift who go together to insert lines.  We do only PICC lines. Our hours are from 0830-1900 daily.  As others have said, this is very efficient and works well for us.  We can have a line place within 1/2 hour of entering the room, if necessary.  While one inserts, the other hands items to the inserter, cleans and preps the patient's arm, places sherlock, charts the insertion in the computer, orders the xray, etc.  If there is a problem with a restless patient or repositioning of the patient is needed, there is someone right there.  I work at a Trauma I-450 bed facility in Utah.  We place roughly 185 PICC lines per month.  Kathy

gretchen
with pediatrics, working in

with pediatrics, working in pairs is EXTREMELY helpful!  There is a lot of prep work that goes into doing a pediatric PICC line.  I call it an orchestration.  One of us can get consent while the other one assesses veins and applies topical lidcaine.  We have to have the whole team come together for the PICC line (PICC RNs,Child Life, Parent?, Sedation Medication, etc), so it does take a bit longer than prepping an adult.  The great thing is, though, we don't have to ask a bedside RN to step away from their busy patient assignment to help us during the sterile procedure... we give the sed. meds, help prep patient, observe sterile technique, open additional supplies as needed, document, and order X ray, while the other inserts PICC. 

I've worked alone for several years doing peds PICC lines, and now have a 2nd PICC RN available, and have to say it is wonderful to be part of a TEAM!

robinsp2
How many vascular access teams use two trained nurses to perform

We have found it beneficial to lessen the stress of time management to work together.  It helps to have another member present to assist in positioning, etc.  The staff has the option to work together or individually which enable them to have control of their working environment and adds to job satisfaction.

momdogz
depending on staffing and number in PICC queue

 we used either a trained medical assistant (trained in observation maintenance of sterile technique as well as assisting in sterile field establishment), or a trained IV RN or PICC RN.  We have a competency training and assessment for PICC assistant that all of our members must pass.  They are evaluated formally every year.

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

Robbin George
PICC [Peripherally Inserted

PICC [Peripherally Inserted CENTRAL CATHETER] are CVCs

Witnessed/Assisted CVC insertion checklist buzz words
Consent/Time out--Hand Hygiene--CHG skin prep--Sterile Technique

ALL these components MUST be.....
[1] Applied to ALL non-emergent CVC placement in ANY patient care area where CVC insertion is conducted
[Not Just ICU--e.g. ER--IR--Infusion Centers--Bedside]
AND [2] SHOULD apply to ALL CVC Inserters [Not Just Physicians--e.g. RN--NP--PA--Techs]

I am sure that no MD has ever been expected to enter a patient's room
[1] Draw the curtain to preserve patient privacy
[2] Protect and maintain a six foot sterile perimeter
[3] Insert a CVC by themselves
[4] Document compliance with ALL checklist components

I think the dirty little secret of single person bedside PICC insertion is like the proverbial tree falling in the woods
I don't think the CVC checklist was designed to be managed on the honor system
So if no one is watching/assisting/monitoring the process then is there really compliance??????? 

Robbin George RN Vascular Access Resource Dept Alexandria Hospital Virginia

Robbin George RN VA-BC

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