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Internal jugular, subclavian access by PICC RN's

I am wondering what states, institutions are allowing PICC trained nurses to access these central sites?  I know that this is being done by respiratory therapy PICC personnel at a hospital  in Phoenix.  I also know several facilities in decision tree states that are doing or about to go forward with this based on approval from their critical care comittee's.

I saw an email from someone in July(fizerjk) that indicated he(?) used IJ as a small bore catheter site for dialysis patients.  I'd love to hear more from this person if they would respond again.  Anyone else having information, experience with this access site, please jump on.  Together we can increase our knowledge, scope of practice and patient care.  sallyvaldezaz 

David Longseth,RN Trauma

David Longseth,RN

Trauma Life Support Center

University of Wisconsin Hospital

You can check out the AVA and INS websites for positions on jugular access with references.

For subclavian access or other techniques,you may not find a whole lot for this country. Here are a few references that might interest you. Most from the UK,and as such I have had a hard time getting the actual articles,but those I do have just reinforce my opinion that nurses should be the ones doing ALL lines.

Central lines inserted by clinical nurse specialists.

Nurs Times. 1995 Apr 26-May 2;91(17):38-9.


Central venous catheter placement: extending the role of the nurse.

J R Coll Physicians Lond. 1997 Sep-Oct;31(5):533-5.


Nurse-led service for tunnelled central venous catheter insertion.

Nurs Times. 2003 Sep 23-29;99(38):26-9.


A nurse led central line insertion service.

EDTNA ERCA J. 2003 Oct-Dec;29(4):203-5


A randomised controlled trial to evaluate the clinical and cost-effectiveness of Hickman line insertions in adult cancer patients by nurses.

Health Technol Assess. 2003;7(36):iii, ix-x, 1-99.


Training nurses to place tunnelled central venous catheters.

Prof Nurse. 2002 May;17(9):531-3.


Vascular access: a role for a renal nurse clinician.

EDTNA ERCA J. 2002 Apr-Jun;28(2):64-6, 69.


Nurse-led central venous catheter service: Christie experience.

Br J Radiol. 2006 Sep;79(945):762-5. Epub 2006 Apr 26


A nurse led central line insertion service.

EDTNA ERCA J. 2003 Oct-Dec;29(4):203-5.



In tennessee we have a very
In tennessee we have a very broad nursing Scope of Practice. With verification of proper training, creditialing and continuing education there is very little that is prohibited/restricted. We only use the IJ not the subclavian at this time (which is fine with me). Patients we currently accept include ESRD, hx of renal failure or transplant. Patients with bilat subclavian obstructions, bilateral mastectomy with lymphnode disection. bilat upper extremity trauma or burns.

Jeffery Fizer RN, BSN

Jeff Hanks
Fizerjk, Are you at


Are you at Vanderbilt?  If no (because I'm familiar with how VUMC completed their training) what process did you use to get the team trained?  Is your service under medical or nursing?  I need to bring jugular placement to my hospital for just the indications you mentioned. 


Jeff Hanks, CRNI-Vascular Access Nurse, Oaklawn Hospital.  Clinical Consultant, Boston Sceintific.

Jeff Hanks, CRNI-Vascular Access Clinical Specialist, Arrow International

Yes, that would be the

Yes, that would be the place.  We are under Interventional Radiology and developed the program under the direction of our medical director.

Jeffery Fizer RN, BSN

Gwen Irwin
Sally, Do you have


Do you have additional information about what states & facilities are allowing IJ PICCs?  I am trying to go down that path for our renal patients.

Gwen Irwin

Austin, Texas 

Hi Gwen,  I never found any
Hi Gwen,  I never found any states that had formally added IJ access to their nursing scope of practice.  I wrote a change of practice for my stat(AZ) and presented it on Feb 25.  It will be finalized at the SOP committee mtg on June 2.  There are places doing this under a decision tree model (their state does not require a formal scope of practice change).  You'll have to determine what Texas Board of Nursing requires.  If you decide to do a scope of practice change for your state contact me.  I'm an AVA member and my contact info is on their member website.  I'd be glad to share what I did.  Are you going to the AVA conf. in Las Vegas in Sept?  Perhaps we can meet.  Sally Valdez
Post Conference at the AVA

Post Conference at the AVA Scientific Meeting will have an "All-Day" education/hands-on session covering this topic.  There are specific requirements for participation in this session.  Check out the website for details! (full brochure should be in you mail-box soon!)

Gwen Irwin
Thanks, Sally.  Texas has a

Thanks, Sally.  Texas has a decision tree similar to what is in Tennesee where Vanderbilt is.  Keep us posted on your SOP meeting.

I don't think I will be at AVA, but have a coworker that will be going.


Gwen, So it sounds like you

Gwen, So it sounds like you can simplify the process by going through the decision tree questions to present a case justifying the procedure to your facility.  It's quite similar except that you don't have to convince a nursing board.  I found that convincing my hospital was almost as difficult.  Physicians don't want to do this anymore but are still reluctant to let it go.  We're finding that in order to maintain competency we really need to open it up(IJ access) to more than our renal pts. which is ok with me.  Tell your colleague to look me up at AVA.  If there are any resources that I might be able to help with let me know.  I'll be interested to hear how your situation evolves.  The technical part is the easiest.  It's getting through billing, precepting, after hrs coverage, etc. that you get hung up.  Keep in touch, Sally Valdez, Phx, AZ


Remember that it is an off

Remember that it is an off label use to put a PICC in the internal jugular.  Cannulation of internal jugular is one thing, putting a PICC in it is another.



Cheryl Kelley RN BSN, VA-BC

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