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Rhonda Wojtas
PICC line staffing

We started our PICC line team in November 2007. There are 3 nurses, one fulltime Endo nurse who does PICC lines when Endo isn't busy, a per deim nurse working currently 4-5 days a week and myself who works 4-5 days a week. When I am not putting in PICC line I work on Ambulatory Care (same day surgery) which is where I worked all the time before I started doing PICC lines.On most days there are 2 of us on together. Part of this was to help each other become comfortable and proficient. 

 We also have a PICC line suite, which is an area at the end of one of the nursing units. The area in not near the nursing station so we felt there needed to be two of us because the area is so isolating. We try to do the inpatient in the PICC room to ensure a sterile environment. Patients in ICU and IMC are done at the bedside. Our hospital is a 200 bed facility that includes ER bed. I believe our full in-house census is about 150. Our PICC line insertion numbers still vary greatly from only 7 last week to 14 the week before.  We also do outpatient PICC lines.   That too varies from day to day on how many we do.

 Today my nurse manager told myself and the perdiem who was working with me that when we move into a different area, there will only be one PICC line nurse on per day. We will set up in a room at the end of the Endoscopy unit and have one of the free Endo nurse help when we need it. Not sure what will happen when we are in a patient’s room and how we will get help if needed. We certainly can't ask the floor nurse to stay in for the entire time of insertion and we all know that can vary from 30 minutes to 1 1/2 hours.  

Now I realize many of you do PICC lines alone. I have only done it with someone there. The perdiem nurse and I work very well together and do a team approach as we work together to set up, clean up and document. While one is finishing up the dressing or cleaning up the other can move equipment to the next area or in many cases transport the patients back, while transport will bring up the next. We can do 3 PICC lines in 4 hours. We have a success rate of over 90%.I feel this is in part due to the fact that if one of us is having difficulty the other can step in and help.

We have very few PICC lines we have to send down to IR now. We are the primary PICC line inserters and IR only does the one we can't.  I guess in my mumbling I wonder how you do it alone. How many times do you break scub? What if you need something because of contamination? Or if you drop something? Do most of you currently work independently?? 

It is my hope that we will increase our numbers of PICC line insertion before they move us so that we can justify have 2 nurses working together.  I appreciate any input or thoughts anyone has. I am new at this and have only been doing this for a few months. I know I am spoiled from having been working in pairs from the beginning. 

Rhonda Wojtas, RN

Why not consider hiring a

Why not consider hiring a clinical assistant who can circulate for you during the procedure.  The cost of having an assistant versus another RN would be significant.  We have 5 full time PICC RN's at my hospital and one full time CA (clinical assistant).  The CA has become an invaluable part of our team.  The position was created without a job description, but she has assumed much of a clerical/assistant duties, as well as being a resource during PICC insertions. 

Wendy Erickson RN
I discourage my PICC nurses
I discourage my PICC nurses from attempting to place a line without help.  We are about the same size hospital as you are.  We DO expect the patient's nurse to assist if we can't find another PICC nurse.  If the procedure was done by a physician at the bedside, wouldn't the nurse be there to assist if needed?  No different for you.  You don't necessarily need an RN though - our nurse aides are wonderful assistants as are student nurses. We mainly need help with non-sterile activities such as placing the tourniquet or helping to reposition or support an arm.  They do gown/mask/glove as we do.  Anything else we can talk them through at the time it's needed.

Wendy Erickson RN
Eau Claire WI

Rhonda Wojtas
Wendy, Thank you for your


Thank you for your input. How many PICC line nurses do you have? Also what is the average of PICC lines inserted in a day?

Yes I agree that a properly trained assistant would be helpful but in many instances the 2nd trained nurse has helped with postioning the arm of a difficult patient. I feel that because we work in pairs we have a higher success rate than if only one trained PICC was working alone. There have been patients I have not been able to access but the other nurse working with my has be able to do. There have been occassion that we have not had 2 nurses on and have had to use someone else as a second pair of hands. My issue is that I don't want that to be the normal situtation.

I feel strongly that you should have either an assistant trained or a second nurse if possible with you the entire procedure. I shouldn't have to hope that the nurses from the Endoscopy unit will step in for a few minutes. I think it is unrealistic to think they will be in there for a few minutes when it might be a difficult start.

Yes I understand a MD doing a precedure at the bedside would have a nurse there. I also know in the years many procedures are no longer doen at the bedside. Many of our procedures such as bone marrow biopsy, liver biopsy and paracentesis are done by IR with US guidance.

The other issue is that we place many PICC lines at the bedside on precation patients. Should we be dependant totally on the staff to step in under those instances?  If one nurse has 2 diffent patients that could take that nurse away from her other patients for an extended period of time.

 I guess I am looking for information to take to the administration to support having 2 trained PICC people on at all times. While I think it would be preferrable to have 2 RN's I do see that and aide could help.

 Rhonda Wojtas, RN

Rhonda Wojtas, RN,BSN, VA-BC

If you don't have an
If you don't have an assistant, get out several pairs of glove to have ready if you need to get something.  Tie your tourniquet before you start.  Wear two pairs of gloves at first.  I hardly ever have help.  You adjust.
Gwen Irwin
We work solo all the time. 

We work solo all the time.  Only if there is a patient that the assessment of the PICC nurse indicates another PICC nurse to hold and support the patient's position do we have a 2nd nurse.  Otherwise, double gloving is a necessity for us.

If something is dropped, the patient care nurse opens the package that needs to be replaced.

We insert more than 275 PICCs per month with 3 full time PICC nurses.

Gwen Irwin

Austin, Texas

Robbin George
I thought double gloving was
I thought double gloving was a sterile procedure NO NO???? Additionally any change of gloves requires that personnel conduct hand hygiene first--The members of our PICC team have always worked alone and your concentration is so focused after you get used to working like that it is actually a distraction having others in the room 

Robbin George RN VA-BC

Gwen Irwin
I am not sure that double

I am not sure that double gloving is a NO NO.

We set up the sterile field and double glove, like kathryns, Vascular Access Nurse, Christus Santa Rosa stated.

Gwen Irwin

Austin, Texas

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