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clhunchusky
PICC triage algorithm

We offer PICC placements 24/7 at a 700+ bed hospital with six nurses who work 12h rotating shifts. Some days during the week we will have one on days and 2 on nights or vice versa. On weekends we have one on days and one on nights. Since we place approx 350 PICCs/month, there are times when the day nurse can have 8-10 orders and of course only one nurse. We have always stated that our PICCs are not emergent. However, the hospital staff have become very dependent on our team and at times can be downright demanding. We have always triaged our requests, and at times there may be several at one time with no access or in need of critical meds, needing more access, to the patient that needs a CT to r/o PE to name a few. How is everyone else handling these situations that I am certain are not unique to our hospital? Does anyone have an algorithm they would share? You may email privately if you like at [email protected]

Thanks. 

cathie
We are in the same
We are in the same position....and currently working on the algorithm...I'll be in touch
clhunchusky
I look forward to hearing
clhunchusky
Cathy, I was wondering if

Cathy,

I was wondering if you would share your algorithm, as we are again revisiting this issue. Thanks! You may email me privately at [email protected]

rivka livni
We established from the

We established from the begining that since PICC insertion requires consent, it is NOT AN EMERGENCY.

Our house staff knows that if it is ergent, they should insert a CVC, it will serve as a great short term central access, and later on if a long term IV access is needed they are encouraged to order a PICC.

Our PICCs are first come first serve.

Once you give power to the physicians to call the shots of how nurses should practice, you may not be able to establish a "team" relationship, where what everyone is doing is what is best for the patient.

I am totally against STAT PICC.

 

momdogz
We don't do stat PICCs, but

We don't do stat PICCs, but we're working hard to get to some of them as quickly as we can and have been fortunate enough to add hours/staff to cover the PICC demand.  Especially with power injectable and triple lumen PICC lines, we're finding in our early vascular assessment that much more often - PICCs should be placed instead of non-tunneled catheters.

If a patient really needs access, even if they're in the ED, and we have no other good options: we place a PICC if we have a PICC RN available (all other assessment variables being acceptable).

We have a great relationship with our docs - lots of respect (except for the occasional ill mannered one) - and if we say "no" or "later", they usually respect it.  If they need to talk with us more and try to convince us - we'll listen.  Sometimes the answer is still no, sometimes they provide us with more information that will make us change our mind.  We're all looking for good patient outcomes.

If I were you, I would gather the data re: your comparative PICC volumes for the last couple of years, do a simple cost benefit analysis, and present to your manager to request more FTEs.

And...I'd be interested in seeing the algorithm also, if you wouldn't mind posting it.

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care

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

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

If you do 350 PICC lines a month that is 11.7 PICC lines a day for 30 days of a month.  I did the math.  You say that you have 8-10 per nurse so that would mean somedays you have more than others and the RN's wait for a PICC line.  Your labor time is 24 hours if you have 2 RN's and 36 hours if you have 3 RN's per day on 12 hours shifts.  It seems that if you are doing PICC lines only you can do 12 per day if there are two of you (24 labor hour days) and 18 per day if there are three of you (36 hour day).  I believe you are not only doing PICC lines!!!!  That is why you are short time.  You need to do an analysis of all you do.  I suggest giving uo whatever else you are doing and concentrate on the PICC lines, map out the lines by day of week and volume for a month, and make patient rounds for triage (early assessment).  Give up the other job duties.  You have enough staff to cover 12 lines per day with coverage of two RN's per day.  Get a low cost tech if you want to do dressing changes and peripheral IV's to  assist on PICC line insetions to cut your time on PICC line insertions from two hours to one hour.  You have enough RN staff a day to do just PICC lines only up to 12-18 per day and you are averaging 11.7 per day.

Kathy Kokotis

Bard Access Systems

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