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mary ann ferrannini
ICU Nurses to place PICCs during the Night
   I need any help out there that I can get ...our sister hospital wants the PICC nurses there to train a few night nurses in ICU to place PICCS during the night. The PICC nurses naturally are resisting knowing full well the amount of knowledge and training that is really involved in placing and maintaining these lines. My personal belief is you get what you pay for.....if you want a quality PICC are going to have to staff appopriately for the volume and find or train an experienced candidate. The low volume of lines that these nurses may be placing most certainly will not be enough to maintain the skill level needed for a high success. rate I forwared a document that I had compiled about the requirements that should be met and what the Ca BRN requires ...educational course required....institutions P and P in place..proven competency and documentation of such on file and yearly proof of competency etc......I quess they want more I thought I would get some opionions out there.....I know that nurses that we have trained in the past without an IV Therapy background have an extremely difficult time learning the skill and  are  a bit amazed at the theoretical background and training that is actually required...some backed out...some persisted. A few years back another sister hospital sent us 3 nurses one day and thought we could train them in ONE Day and not one had an IV therapy background......I thought "Are you kidding me"...if you do not know what is involved than PLEASE listen to those that do. The long and short of that is that it took us 3 mos of intensive training to get them up and running and mos and mos of phone support with clinical issues....any help out there or advice....tx so much    Mary
Nancy Safranek
We're a small community hosp
We're a small community hosp (100 beds) where PICCs are placed by "SWAT" nurses 24/7. While not a completely dedicated IV team, PICCs and IV are the biggest share of our routine workload.  BUT we also get pulled into staffing in the ICU (and elsewhere) where some of us are fully  ICU qualified and others take the lower acuity ICU patients.  The bottomline is that, day or night shift, whenever we have had assigned patients and have consented to start PICCs bad things happen.  No matter how fast you are, your other patient or patients are neglected or things (like loosing the guide wire in the patient) have happened because someone was trying to work at light speed.  As far as volume is concerned, our night shift in ICU would have the highest volume of PICCs placed (if there were always a SWAT available) so it would be possible to become more than minimally competent if the physicians were content with PICCs (ours love them because they don't have to come in and start central lines unless they want continuous SVO2 monitoring).  Just my thoughts.

Nancy S.

I mean know disrespect for

I mean know disrespect for critical care nurses in my response here, but I do not believe that they bring the necessary knowledge and skills to insertion of PICCs. They will always have a full assignment of patients and will never have the time necessary for safe PICC insertion. In 20 + years of teaching PICC insertion, I have never seen this work and will not provide the education to hospitals that plan such an approach. Would you send your family member to a heart surgeon who performs limited numbers of CABG procedures per month or do you want the surgeon who has a high number of procedures per month? Experience increases proficiency which leads to better outcomes. This can not be accomplished with nurses who have limited chance to perform the procedure. I would never attempt to manage the hemodymanic status of a complex trauma patient on multiple pressor drugs and a ventilator, yet many ICU nurses can do this easily. So we need to respect the specialized skills associated with each aspect of patient care. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

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

Stat piccs

I have some issues with stat picc placements and find they delay proper patient treatment.  Recently we had a patient in hemovolemic, cardiogenic shock on the floor.  They wanted a picc placed immediately so he could receive dobutamine, lasix and dopamine all titrated.  My response in this patient with altered mentation and a B/P 90/60-80/50 was that he needed to be moved to the ICU and lined immediately.  Another picc nurse performed the procedure and was unable to achieve placement in 3 hours.  The patient was sent to ICU and dopamine could not be used through what was essentially a midline.  He did not get seen or treated by IR and have his picc adjusted for 2 days.  His hypovolemia was treated with fluids, which further decompensated his cardiac function as they could not use pressors.  This is not a nurse advocating for what is best for the patient in my opinion.

Diane Suter, RN, VAT

Gwen Irwin
Years ago, we tried to have

Years ago, we tried to have PICC nurses available to do PICC during their shifts.  It was a disaster.  Patient care suffered during the PICC insertion.  None of these were ICU nurses.  I can only imagine more complications with this type of approach.

In our current high tech world of PICC insertions, I would questions whether an ICU could really be competent and successful.  I would absolutely take a stance against this practice.

Gwen Irwin

Austin, Texas

A few years ago we needed to
A few years ago we needed to have a per diem nurse on our PICC team to help cover vacations etc. We chose to train an ICU nurse who was interested in placing PICCs. She worked out very well for us as a per diem because she was one of those nurses who seemed to be a natural at using the high tech tools for bedside PICC placement. That being said she only placed one line while working an off shift in the ICU. She said that on that particular day she was charge and could spare the time to do the PICC but would never attempt it if she had a patient assignment. The reality is that an experienced team makes PICC placement with ultrasound look like a piece of cake but once a nurse is actually trained he/she realizes what a complicated procedure it can be. Trying to "fit in" a PICC while having a patient assignment is completely unrealistic.
Dan Juckette
Daniel Juckette  RN,

Daniel Juckette  RN, CCRN

The real question seems to be How Emergent are PICC Placements? Is this an emergency procedure that needs to be done stat in the middle of the night?  If so, the organization that has a PICC team should be willing to pay on-call and call-back pay to have a skilled PICC nurse available emergently. If they choose a poorer quality solution the poorer quality outcomes will come back to bite them. There was a study in JAVA a couple of years ago that showed it costs upwards of $25,000 to train one PICC nurse to full competence. Once you have done that you have set an institutional standard that can cause serious problems with regulatory agencies when you lower it at certain times of day for financial reasons. The concept of Emergent PICC placements needs to be seriously challenged.

Daniel Juckette RN, CCRN, VA-BC

mary ann ferrannini
  Thank you for all the
  Thank you for all the responses   I appreciate it!!!!!
24/7 Vascular Access needs

I think placing PICCs needs to remain a long-term soloution access device where a centrally placed central line and a PIV suffices for more emergent needs. In the middle of the night a hospitalist can place an emergent central line. Calling in a PICC nurse to place a line that will usually take a longer amount of time is a self limiting solution as a PICC is the only line that can be placed by this nurse. If the line needs to be in stat, then other options that are available to the hospitalist are not available to the PICC nurse, such as subclavian, femerol or jugular (some PICC nurses are placing jugulars, I understand, however). I think 24/7 coverage for IV access with that inserter being able to place any and all lines is a good idea, but PICC inserters don't have the skill to provide the right type of line for all needs 24/7.

I have always said and I

I have always said and I stick by my training motto:...2 months to train, 2 years to master. The question these hospitals have to ask themselves you want a nurse that can place a PICC , maybe...or do you want a PICC nurse. It sickens me when I read about these kind of cases where an ICU nurse or any nurse is quick- trained to insert PICC's. What is sad is, that if something where to happen, and you were being sued,...what would be your defense...I had 1 week of training and placed 1 a month....a prosecuter would be drooling over that scenario.

We now have a Board Certification...that has to stand for something....GOOD POINT LYNN !!!!

Jack Diemer, RN, BSN

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