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Catherine Little
PICC placement competency
Any standards about how many PICCs should be placed per month for the RN to maintain his/her competency?
lynncrni
No, this does not come down

No, this does not come down to XX number of insertions per month. Competency should be tied to outcomes. Look at the outcomes of your insertions and maintenance procedures. That will direct your attention to what needs to be improved and that will guide you to determine your competency assessment program. This program should change periodically based on those outcomes. To have a nurse demonstrate placing a PICC on an anatomical model before an instructor at a certain frequency is pointless and a waste of time.  

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Catherine Little
Thanks Lynn, we currently
Thanks Lynn, we currently track number placed and success rate "Success = insertion into vein and utilization of line." Other suggestions re outcomes tracking?
lynncrni
A successful vein entry does

A successful vein entry does not mean a successful catheter placement. So tracking that would also provide information about the reasons for unsuccessful catheter tip location. Also I would be tracking the clinical outcome with the catheter - infection, thrombus, lumen occlusion, etc. For these you may find that the competency to be documented is not related to the actual insertion but is related to the nursing care given to the patient and device.  

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

No, there is no standard out there to benchmark against.  It is defined by your institution

Kathy Kokotis

Bard Access Systems

monicasorg
Catherine Amero

Catherine Amero MSN/Ed,RN,CRNI®, Nurse Educator, Infusion Nurses Society recently sent me the following statement. Section B might be helpful to answer your question. Personally I think it would be a nice practice to have a quality assurance program to periodically watch each other on your team insert PICCs. Not for criticism, but for an accountability check...to make sure we aren't getting sloppy with our technique. That could be used as a yearly competency evaluation.

From INS Nurse Educator:

Clinicians caring for, inserting, and providing course instruction on PICCs should have specific education for these practices. The Infusion Nurses Society makes the following recommendations:

A. Clinicians Caring for PICCs

Areas in which clinicians caring for PICCs should be knowledgeable

1. Routine nursing care tasks

a. dressing change

b. tubing/injection cap change

c. flushing

d. blood withdrawal

e. device removal

2. Complications associated with the chosen vascular access device (VAD) and the recommended methods to manage those complications

3. Resources to contact when assistance is needed

a. nurse who inserted the VAD

b. manufacturer's clinical support

4. Documentation of outcomes and quality improvement

5. Design, indications, contraindications, and precautions for the specific VAD being used as written in the manufacturer's literature

6. Parameters for methods of infusion

a. flow rates

b. fill-volume of catheter

c. pressure ratings and limits of catheter

d. infusion pressure from chosen flow control device

e. considerations for manual injections with syringes

B. Clinicians Inserting PICCs

1. Documented 1600 hours of clinical practice in infusion therapy responsibilities over the previous two (2) years

2. Documented experience in central venous access device (CVAD) management

3. Completed a didactic course in PICC insertion, care, and management

4. Completed a practical component which shall include supervised and/or precepted PICC insertions by a qualified instructor until competency has been determined including

a. the didactic component

b. emphasis on the ability to perform the insertion procedure safely

c. the clinician must be cognizant of his/her accountability for the outcome

5. Responsible for meeting the organization/facility requirements in order to maintain qualification

6. Complete annual organizational competency validation

a. review of didactic component

b. practical component

C. Clinicians Providing Course Instruction for PICCs

1. Meet the educational recommendations for Clinicians Inserting PICCs

2. Documented five (5) successful catheter insertions to precept or observe the PICC insertions by another clinician

3. Documented twenty-five (25) successful insertions to instruct PICC insertions

4. Documented comprehension of adult principles of learning (derived from the organization's existing educational structures)

a. assessment of learner's needs

b. program development processes

c. appropriate teaching and learning strategies

d. evaluation

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