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Julie Shomo
One versus two clinicians for PICC insertion?

The demand for services of our vascular access team has increased significantly in our 1000 bed hospital. One suggestion is that we do PICC placements separately rather than having two clinicians at the bedside.

I cannot find literature to support either option and need to present "best practice" evidence to support the direction that is taken.  Personally, I feel that when I have to do a PICC by myself, I am a greater risk for contamination of the field.  If I needed supplies I would have to reach into a bag or drawer and could easily contaminate the gown even though I change gloves. If I called for help, I could probably push the call button maintaining the field, but I might wait twenty minutes before someone comes to help. If the patient gets restless, the field could be easily contaminated.

However, with the economy forcing extreme care in maintaining the best quality of care possible with the money available, every decision has to be supported by evidence.  If research is not available, we must do what the majority of other facilities are doing.

Does anyone know of research on the topic?  If not, what is your practice regarding PICC placement?  If there is an assistant, is it an RN or non-RN?

Thanks for your help!!



Paula Happel
I would agree with you, it's

I would agree with you, it's difficult to maintain sterility doing a solo PICC insertion. Would you want  a surgeon to stop & get his own supplies & change gloves?? How can you be sure your gown isn't contaminated if you leave the sterile field?  We use a tech to help us with insertions & sometimes we have to get someone off the nursing unit to assist if our staffing is too tight. When an inexperienced staff person helps, there's often a contamination. It is amazing how poorly the concept of sterile technique is understood. And we all know how tight the staffing is on inpatient units, so they really don't have time usually to send someone in for 30 min or so. An experienced and trained tech can make a world of difference & make things go much faster as well. It would also be less expensive than RN wages. I would think wasted supplies & extra gloves expense & insertion time would all be higher without an assistant, but it would be interesting to see a study.


Paula Happel, RN, MSN

Mercy Medical, Cedar Rapids, IA

Paula Happel, RN, MSN

Mercy Medical, Cedar Rapids, IA

In December of 2008 we

In December of 2008 we adopted the model of having a two person insertion team.  The role of the second person is to ensure that sterility is maintained through out the procedure.  The second person is empowered to stop the procedure (if safe for the patient) if any breach in technique is witnessed.  We have extended this to ALL central line insertions.  In meeting this new expectation, we have employed a skill mix change on the PICC team utilizing nursing assistants as the assistant.  The nursing assistant is trained by our OR colleagues in sterile technique (gloving, gowning, sterile field preparation).  A checklist is used for all central line insertions, including PICC insertions, that delineate all steps in the procedure were followed per policy.  If all of the steps were followed correctly, a green sticker is placed on the lumen of the catheter.  If, as during an emergent CVL insertion, steps were missed, a red sticker is placed on the external lumen.  This is an indication to the team that the line was placed in less than optimal conditions and should be changed as soon as the patient condition warrants.  I would be happy to send the reference if you are interested .. I don't have it with me at this moment.

Janet Mulligan, RN, MS

Nursing Director ~ IV Therapy

Massachusetts General Hospital

Boston, MA

We also practice with a two

We also practice with a two member team and find we are not only more effecient but more SUCCESSFUL at getting lines in.  The second person who is also an experienced picc nurse can offer suggestions and help perform arm manuevers with lines that don't want to thread easily.  We tend to alternate rolls as we insert.  This reduces fatigue, allowing us to get through a ten hour shift without breaking our backs. 

Unfortunately we don't have a time and motion study to prove that this is more productive.  Admittedly we could get a lot more piccs in if we could schedule them and had a picc suite. We are constantly triaging and running from unit to unit based on need.



Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA


I have not seen any

I have not seen any literature on either model. I suggest you arm yourself with data and do your own time study and see what you discover. We did this at my organization and found that together we were actually more productive. A 2-person team could easily place a PICC in less tham 30 min (not including chest film follow-up, etc) while alone we took twice that and used significantly more supplies with all the risks of infection that the others have already stated.

I am a vetern PICC nurse and

I am a vetern PICC nurse and was trained to do PICC's by myself. I have been able to perfect my technique over the years so that I have a system, much like when you learn to do peripheral IV's, on how to set up and put the line in myself with out contamination. I happen to prefer doing them by myself, as I find a second person throws off my routine. However, I am in a facility that has always practiced with two nurses. I agree with best practice and have been unable to find literature myself to support either doing PICC's alone or with 2 people. My frustration is that our PICC numbers have grown so much that it is not feasable to have two nurses place a PICC with their current system. It takes anywhere from 1 hour to 2 hours for two nurses to place a PICC. I have done them myself in @ 45 min. to an hour. I would like to know how other teams have set up their system to be efficient for placing lines with two nurses?

Thank you, Robin

Glenda Dennis
We use ECG guidance for PICC
We use ECG guidance for PICC placements.  If two people are doing the procedure, we can complete it with documented evidence of tip location in 30 minutes.  No chest x-ray is needed. 
This is the link to the
I worked solo for years
I worked solo for years placing PICC lines.  Since starting the new PICC line department at the facility I am at now, I have been using the 2 Rn method.  Intially this was for training purposes, but I have also found it to be quite beneficial for many reasons.  The patient is far less anxious if one person is explaining, scanning the vein, and measuring while the other is setting up the sterile field.  The procedure goes like clockwork while the inserter focuses solely on the patient (not setting up their tray).  There is always a second person there if any need arises.  While dressing the PICC line and cleaning up, the second person finishes the paperwork and it's on to the next one!  It is much faster and reduces fatigue, as we take turns.  I have trained my staff to do them either way, but think it is easier on the patient and inserter to have 2 people present if possible. 
We only have 2 nurses who
We only have 2 nurses who routinely place the PICC lines.We try to both be present during the procedure but on weekends or holidays there is only one of us on.We try to inform the Docs that if they order a line on the weekend,chances are they will not get it until Monday...its not a very good system.We can only get fluro assistance is certain radiologists are on,as some don"t "do" fluro for line placement...
We use 2 person teams with a

We use 2 person teams with a checklist to ensure all steps were followed appropriately and breaches corrected appropriately.  We're all skilled enough to do U/S guided PICC insertions independently, but I would not recommend it. 

I agree with the others about, in addition to increased patient safety, increased efficiency and increased overall success. 

Solo clinicians should never leave a room when a sterile field is established.


Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

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

Gwen Irwin
Due to the demand, we do

Due to the demand, we do solo PICC insertions.  However, we do have a few people that like 2 PICC RNs.  We are so small a team that it could impair our response time and our monthly insertions, if we rely on 2 person teams for PICCs.

Gwen Irwin

Austin, Texas


what system are you using and are you still taking a post insert. cxr?


what system are you using and are you still taking a post insert. cxr?

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