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Minimal Training requirements for nurses learning Modified Selenger / Ultrasound guidance PICC insertions.

Lynn could you comment on what you would consider the minimal training for a nurse to insert PICC lines utlizing ultrasound and modified selenger technique.  The nurse would only do them on a PRN basis. Also understanding each individual learning experience is different, what would you think the minimum should be.  Thanks Kris 

I have never seen any

I have never seen any published data on establishing such a number. I think that Bard Access is still stating that it takes about 50 insertions with US to get comfortable with it. MST usually is not that many. It sounds like you are talking about nurses that do not have infusion therapy or vascular access as their primary focus in their practice. And you said they would only be doing them on a PRN basis. I would say a minimum of 5, maybe 10 completely successful procedures. Of course, it may require a total of 50 before they reach this number of completely successful insertions. Then there is the issue of the amount of time elapsing between each attempt. We do know that repetition of any procedures leads to better outcomes. So it there are long delays between these attempts, this process will be extremely slow. Lynn

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

hope you don't mind my comments......

When we train nurses/mds from outside of our facility, our ideal training enables the clinician to place 5 PICCs independently under our supervision by the time they have completed the competency training and assessment.  This varies from individual to individual, depending on how much time they are able to spend - usually related to cost to individual or facility of sending someone/their meals-lodging/training itself, etc., what kind of cannulation and PICC insertion experience the clinician has, and the skill of the individual.

For the above ideal to be met, it usually takes 5 full days of training - and then sometimes local folks choose to come back for more hands on because we have a high volume of PICC placements and they can get more experience.  Some choose to come back after a year if they haven't had many opportunities, and get more hands on.

5 is the minimum for very basic proficiency, from my personal professional experience with all of the people we've trained, and the feedback we've gotten from them. Some that can't stay to reach that 5 PICC goal, say 2 or 3 - then will finish their training in their home facility with IR, or work something else out.  Because 5 is no where near enough experience for a clinician to develop good critical thinking, problem-solving, and U/S probesmanship, we provide telephone and email support after the training.

I would say 50 is in general pretty close to the number needed to reach adequate to good proficiency and confidence.





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

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