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PICC competency

 I could not think of a better place than a forum like IV to request opinions and assistance from PICC nurses who may be able to relate to my dilema.

I work on a PICC team that services inpatient and outpatient needs for vascular access.  We are available to place PICC's 6 days a week from 8-8p.  We have been approached on multiple occasions to consider training a handful of nurses to place PICC's during the hours that we are not there.  The request is based on the rare occasion that a need for emergent access is needed and a PICC is ordered during those hours a PICC nurse is not available.  We have verbalized in the past that a PICC is not the emergent access device and that a percutaneous CVC should be the catheter of choice.  We have also expressed that training nurses who do not insert PICC's on a daily or even part time basis may not be as efficient or safe in an emergent situation let alone any situation.  We also expressed that when a PICC is ordered a thorough pre assessment is completed to ensure the PICC is the appropriate device.  It is concerning that the request to train a few nurses to insert PICC's that can not wait for the next day is going to be misused, not to mention inserted by nurses who may not be as proficient due to the lack of practice. Patient safety should always be the first and foremost concern.  I have been a IV/PICC nurse for over 15 years and know the risks that exist when inserting a PICC.  I have seen experienced PICC nurses including myself be in situations that have or could have had very poor outcomes for patients.  We have offered to be available or on call for those hours that they are requesting but not have had a favorable response so far.

It is very hard to explain to health care providers who do not place PICC's what it entails to establish an access (PICC) that is safely placed and appropriate.  Despite our efforts to explain that it takes more than just knowing how to place a PICC that is required to be successful.  There is alot of considerations that take place prior to and during insertion, I am sure all of you know what I am talking about.

I am hoping anyone reading this can suggest any articles or position papers regarding what is or should be required for placing PICC's on rare occassions. I will search online with INS and AVA but was wondering if anyone on the top of their heads know of any article that can sum up what I am trying to explain in a nut shell. I feel that the vascular specilist or PICC nurse is specilaized for a reason.  I would really appreciate your thoughts and any type of literature that could support the suggestion that bedside nurses inserting PICC's should practice this procedure on a consistent basis to ensure and maintain competency and proficicency.  Lastly, what is everyones annual competency requirements in your hospital?

I would really appreciate your thoughts.


Thank you

 The decision makers at your

 The decision makers at your facility have no idea what they are asking so you must educate them. First is documenting competency, required by Joint Commission and INS Standards. This is no easy task and requires dozens of supervised insertions before one is considered to be competent with the US gudiance and PICC insertion. There is no recommended number of insertions to obtain competency - instead the procedure is repeated under supervision in real patients until competency has been reached. Here is a resource that will help with this issue:

1. Moureau N, Lamperti M, Kelly LJ, et al. Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training. Br J Anaesth. 2013;110(3):347-356.

Also this is recognized as a CLABSI issue. Check out this document:

1. Marschall JMD, Mermel LADOS, Fakih MMDMPH, et al. Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology. 2014;35(7):753-771.

This document contains a section on Implementation, which has a portion on education. This is at the end of this paper, Section 6. 

Time and resources to educate and document competency on a few nurses to cover during the off-hours is a waste in my opinion. It will require dozens of supervised insertions for each of these nurses. How long will this actually take for the given number you want to train? Lets say there are 5 of these nurses and each will require a minimun of 25 insertions each to document their competency. How many PICCs does your facility insert each week or month. You will need a minimum of 125 patients to document competency for 5 nurses and probably more. Also who will provide these nurses with the educational course needed before PICC insertion begins? Finally, what impact will this practice have on your CLABSI rates? Can your facility afford this? 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

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