Forum topic

The hospitals in Atlanta with IV Teams (about 6 that I can think of quickly) are all full-service teams that do peripheral sticks as well as PICC and midline insertions. My father and sister was recently a patient in one of those hospitals where the IV team was called to do all their IV starts and restarts. The only exception was when they were in the ER. Contact me privately and I can give you names of people and hospitals to contact for more information about each.  

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

www.hadawayassociates.com

Kathy Kokotis

Bard Access Systems

Mayo has technicians doing IV starts - 80 of them

North Memorial in Minnesota just went to technicians and won their suit from the union to allow tech's.  In Minnesota techs can do IV's

University of Michigan has LPN's do the PIV's

Kathy

We are 700+ bed hospital  placing 300-350 PICCs and only maybe 15-20 peripherals per month. We have been working on an early assessment program/vascular access algorithm  that we have implemented recently. Over time, having the in-house PICC team available 24/7, floor staff had become complacent and were halfheartedly or no longer even attempting to start peripherals. We were getting alot of requests for PICCs for pts that are now labeled "hard sticks" or "poor access".  Many of these pts were only receiving therapies such as hydration, or occasional pain meds, blood, etc.  By doing the early assessment we have been educating the staff in the appropriate use of PICCs vs. other access devices that might be more appropriate for the duration and type of infusate they will be receiving, potential risks v. benefits, among other factors.  Over the past few months our PICC numbers have gone down and our peripheral starts have increased dramatically. Last month we placed 259 PICCs and 89 peripherals! We are excited that we have successfully increased staff awareness, but concerned since placing PICCs is revenue producing vs peripheral US placements are non revenue for our team. Pts who need peripheral access are no less important than those who need PICC access. However where we were once juggling the occasional peripheral start request in-between the PICC requests, we now find that our PICC requests are having to wait much longer due to the increase. I have inquired about billing for the PIV insertions by our team  like we do for the PICC insertions and have been told it cannot be done. Could we  bill the cost center requesting the peripheral starts? This would at least be a positive flow and also encourage staff to at least seek out their own resources (as they did before our PICC team was available) before they call the PICC team and incur those charges to their department. How are other hospitals handling this situation and what is acceptable? Thanks for your responses.

Clhunchusky, can you please tell me how you produce revenue placing PICCs on inpatients.  Is there a particular way you code it or what.  I have not been able to make this happen and I've very curious.

Thank you

 Sorry for being so late in commenting onthis thread..... We are system with two hospitals for a total of 325 beds. The staff including the ICUs have become more complacent each year.  We staff with 1.5 per shift. PICCs average aroudn 70 per month. peripheral IV starts and restarts average around 850 per month. We have approached management and education on several occasions regarding the diminsihing skill level of the staff nurses. The attitude is that in the increasing busy environment the staff nurse has no time and would be less efficient than an IV nurse. Meantime, yesterday I had a stat call on a seixing patient and a stat call inthe ICU on a fresh STEMI patient, both at the same time! What a shame the ICU staff working and /or standing lokking, in the room couldn't even put a tourniquet on the patient!

 Before you know it the staff nurses wiill be so busy they can't even take out an infliltrated IV. What is really frustrating about this is theincreasingly glib attitude these nurses have about IVs. They seem to feel they have no accountability  or responsibility for care and trouble shooting.

Jose Delp RN BSN

Clinical coordinator IV Team

Upper Chesapeake Health

I agree that with more and more responsibilities and paperwork the bedside nurse does not have enough time to do everything they are required to do or want to do for the patient.   Nor are they efficient or effective with IV skills--even more so now with very little education in that area and nursing schools churning out students as fast as they can.  Ultimately the patient suffers for their deficiencies.  I fully support the concept of a full service team.  However, I also think the nurse should develop good assessment skills as well as intervention skills.  They do not get these in school either and so must learn "on the job".  Education is part of a vascular access team's responsibility and it must be continuous. Unfortunately it is impossible to do if you are not staffed properly which seems to be the case for many of us. 

It is easy for the staff nurse to take advantage of a vascular access nurse as well.  I have had nurses call me and ask me to "check" an IV for them.  As if I had time to do PIV assessments throughout the hospital.  That's when I teach them how to do the assessment and determine action to be taken.  If they don't learn from us they will learn from those before them that may or may not have good skills themselves.  You can make the nurses accountable but you have to have the time to do it.  it is a frustrating situation.