I could not think of a better place than a forum like IV therapy.net 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.