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Number of inpatient PICCs placed ?increasing

I know this subject has been discussed previously, but I'd like to get an update.  I'm at a 400-bed, trauma 2 hospital in Oregon. We place about 100 inpatient PICCs per month...1330 total last year.  At a recent infection control meeting, one of the RN ICU directors stated she thought too many(unneccesary)PICCs were ordered.  I disagreed, but she has a very loud voice and is a very large presence and I'm afraid she may influence some of the physicians adversely.  One other nurse said she came from a hospital our size and they didn't place nearly as many PICCs as we do here...I think she came from the southern US.

  I'd like to know what some of your numbers are...esp. in the Pacific NW, and California...but in other areas, too.  I think your numbers might have some influence on the docs.  I'd hate to see this hospital go backward respecting vascular access.



As long as you follow a set
As long as you follow a set of assessment criteria for placing PICCs, it doesn't matter how intimidating this director is. What also needs to be looked at is if the PICCs accomplished the desired outcome for the patient.

Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]

I agree totally. I am

I agree totally. I am located in the south and know the wide variation in services among hospitals here. Several large urban hospital in Atlanta have full-service 24/7 IV teams and places thousands of PICCs annually.  But a large teaching institution here is just now developing a team. Many large southern cities do not have any type of vascular access service or infusion therapy service in any of their hospitals, but I think the same can be said for any area of the country. 

I would agree that there are times when peripheral access that can be seen and/or palpated is exhausted and a patient could get a PICC for only a few days. My presentation at INS this year was about infrared technology that will help us overcome these situations and to avoid some CVCs that may not be necessary. But if you have a defined criteria for your assessment and documentation of good outcomes, your own data will overcome this internal resistance.   


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

I agree with comments so

I agree with comments so far. If you have defined criteria and maintain your data on outcomes you should be able to silence the nay sayers. It is interesting that these broad statements of "We do too many PICCs around here" often come from people not at the bedside who don't see the devastaing effect many of these IV medications and fluids can have on patient vasculature. A good PICC team will review the patient's chart and if a PICC is not indicated will place a PIV and dicuss the case with the PMD. Those teams that just go and place a PICC because it was ordered with no real critical thinking may have trouble defending their practice.

I come from a 250 bed community hospital in western NY and we have placed 1400 PICCs annually for the last few years. This complaint pops up now and then and our numbers will drop for a month or two and then go right back up to 100-120 per month.


You could always look at
You could always look at your length of dwell for the PICC to determine if you are placing PICC's for short term therapy that could have been met with a PIV.

Cheryl Kelley RN BSN, VA-BC

Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Google Harnage and read her article on zero infection rate.  You will find she is at about 2,600 PICC lines per year in a 350 bed hospital and I am not sure of their daily occupancy.  They do about 7 PICC lines per liscensed bed per year.  That is my average in a hospital that has an early assessment program.  I have a number of hospitals that do 10-15 PICC's per occupied the key word being occupied beds per year.  If I knew the number of occupied beds at Harnage's hospital it is likely she is at 10-15 range which is the norm.

In your facility you said you do 1,300 lines in 600 beds which equates to 2.16 PICC lines per bed per year.  you may want to compare yourself in PICC's per bed to local hospitals in your area.  I would hazard a guess you underutilize PICC lines

Another way to find this number is to look at the number of patients with a LOS of over 6 days and how does that number compare to your CVC placements overall.  Of coiurse exclude areas like psych.  Your are likely to find this number is aboiut 8,000 patients per year.

Kathy Kokotis

Kathy Kokotis

Bard Access Systems

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