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Job Security

Life is changing fast.  One out of two hospitals is laying off this year.  Hospitals are cash short on hand and it is not going to improve this year or next.  IV Teams are being disbanded again.  You need to protect yourself this year and this is what you need to think about

Stop doing peripheral IV's as they will not save your job.  Anyone can place one of these.  Look to Minnesota that has gone to technicians

Get into the ICU.  ICU is not laying off and is in fact hiring staff.  Rapid Response teams are growing, and census in this unit is climbing or holding steady.  Start placing lines there, do dressing changes there.  Be part of the infection reduction team.  No one lays off those supporting the ICU!!!

Start monitoring your infection rate yourselves.  Do not let your infection rate be combined with anyone else.  Why do you want your rate lumped with MD's rates.  How do I as the CEO know what you do for me and why I want to keep you

Write a summary plan of how much money you have saved the hospital by not sending lines to IR and your low infection rates.   Include how many hours you have opened up the IR suites

Start staff competency programs with check-off for dressing changes, declotting, drawing blood safely friom a lline, care and maintenance of line.  Make web based courses with competency questions and certificates.  Get moving on this.  You are the experts in your facilities

Start monitoring your outcomes and start writing them up and presenting them to your hospital commitees

Add technicians to your team to do PIV's or assist in PICC line insertion to save money and speed insertions.

Thiink about going to 24/7.  Yes hate me.  Providing service 24/7 keeps you employed

PICC lines are an emergency and so are their placemnt so get over it.  You need to implement an early assessment program and monitor this program for improvement

This is a very dangerous time.  Independent contractors can do what you do and possibly at a lower cost if we are just talking sticking.  Technicians can place PIV's and at a way lower cost.  Technicians cannot do early assessment and PICC line insertion (at least the low cost type)  You need to make a plan. 

Don't tell me you do not have the time for this.  I don't care if you have to do it on personal time.  You will have plenty of time when you have no job.  My brother is putting in twelve hours a day six days a week on a fixed salary as a  computer programmer.  He has three kids under eight and a stay at home wife.  He has a Job!!!  Jobs are tight!!

You have now gotten the outline of my AVA talk 2009.  I do not have the luxury of waiting for Sept as this is getting worse by the day.  You need to start now.  2010 is predicted to be way worse than 2009 for healthcare.

Kathy Kokotis RN BS MBA

Bard Access Systems and yes this is a full disclosure of my employment and I am biased 




Right on Kathy, you always

Right on Kathy, you always tell it like it is and I love you for it.

One more point, we have Pharmacy send us every Monday, a weekly report of all patient's name in the hospital who receive Vancomycin for more the 5 days, PPN, TPN, Amphotericin, and all IV Chemotherapy (it is arranged to come to us in a secure site). We found out that many Physicians do not order PICC for patients who obviously need it. If you can get the Pharmacy's IT person to send you the reports you may be surprised to see how many patients are on pretty strong medications and do not have any CVC.

I found out that Physicians do not have any formal class on IV Access as part of their training. They do learn how to place a CVC but they do not know why do PIV fail, what is the pH of different medications or the Osmolality of IV solutions, or the physiology of veins. If physicians do not know that, they are not likely to order a PICC unless the nurses complain that there is no more IV Access for the patient.


Looking forward to hear your talk in Las Vegas.

Rivka Livni PICC RN

Timothy L. Creamer
100% agreement Kathy. Early

100% agreement Kathy. Early assessment programs especially in the critical care setting are significant for proving and securing each teams value. Take ownership of PICC's and acute CVC's for continuum of care surveillance and maintenance, start in the ICU. Don't forget about the Emergency Department either, have placed many PICC's in that department.

Request as much clinical support from your PICC manufacturer as you can, work smarter, not necessarily harder. Company Clinical Specialist's should have all the tools to assist a seamless PICC program transition. If you use Bard products then do not be shy, call and take advantage of as much clinical support as possible.

Rivkalivni PICC RN, great utilization of pharmacy! Perfect proactive versus reactive approach.

I also agree with Kathy about 24/7 coverage. Vascular access needs are 24/7. The attitude in the PICC world requires a perspective shift. In my opinion and experience, PICC's can be urgent, emergent, stat. PICC usage has evolved from the single lumen line required only for extended length of therapies or outpatient population. PICC's can commonly be first choice of central access, not to substitute a skilled physician placing an acute CVC when indicated but to decrease risks and possible delays in the absence of 24/7 intensivists.

It is not about just placing a line, PICC team's have the skill and knowledge to utilize the nursing process, include the infusion process, provide the optimal vascular access for our patients.

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Florida Division

Timothy L. Creamer RN, CRNI

Clinical Specialist, Bard Access Systems

Florida Division

Gee Kathy, you were just a

Gee Kathy, you were just a ray of sunshine last Friday!! I am not disputing that trained technicians are in our present and future, however, there is one factor that you have overlooked. This would be considered to be a delegated task - a task delegated by the RN to the unlicensed personnel. Because of this, each hospital and nurse must work under policies that are in accordance with the rules promulgated by each state board of nursing regarding such delegation. So make sure you know what your board's statements actually are about delegation. 


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

Dear Kathy,  You always

Dear Kathy, 

You always "PICC" me up when I'm down!  :-)  

You "Complete me"!

You are right on the money baby!

I could go on & on...but seriously, I whole heartedly agree and you give great advise. The only problem that I can see from convincing our admins is that 

PICC lines ARE an emergency. How do I convince them? Or is the term "Vascular Access" more appropriate?

 Your thoughts?



Raquel M. Hoag, BSN, RN, PHN, VA-BC

The Association for Vascular

The Association for Vascular Access is having a pre-confernce that may of interest to you at the annual conference in September in Las Vegas.  One of the courses discusses:

1) the situation in health care ecomonics today and

2)offers tools for you to document, track and verify that indeed your existence is critical and necessary. 

 The session is entitled   Managing in a Time of Change: It’s All About Data! and will assist you in gatehring the data that will be required to document rationale for the continuence of your services.  I have copied a description for you.  

The Managing in a Time of Change workshop will address the national economic challenges that have taken a toll on hospital admissions and services. Chief operating officers may see vascular access programs as an easy area to trim costs. Data collection of the services provided will be critical in assuring the survival of this very important specialty. This full-day workshop will arm the vascular access manager with ideas and “take-home tools” that will assist them in justifying the continuation of service and maintain financial strength which protects their existence.  Samples of three different data collecting systems will be examined that focus on the smaller, intermediate, and large medical facility. Three interactive afternoon sessions will allow the participant an opportunity to look closely at the data collection tools, evaluate case studies regarding vascular access productivity and sampling of the outcomes monitoring tools. This new management program will assist the learner in providing for quality vascular access while at the same time meeting the cost constraints for survival.

Info will be coming soon on the conference.  Stay tuned!

Cheryl Kelley

Cheryl Kelley RN BSN, VA-BC

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