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sandy Collier
Success rate for PICC insertion at bedside

Our hospital just started allowing the IV Team to place PICCs at the bedside.  Our success rate is  not where we want to be.  Was curious to know how other IV Teams did in the beginning stages with PICCs at the bedside. 

Any information would be greatly appreciated.

Thanks!

Sandy

Rhonda Wojtas
Sandy,   First let me say

Sandy,

 

First let me say that I am a very new PICC nurse. I have only been doing them since Nov. When I first started yes our success rate was not as good as I wanted. Maybe 60-70 percernt. Everyone told me with time it will get better. We now have a success rate of over 90%.

 I guess a few things would be are you using ultraound? Are you using a tip locator device? Are you working alone or do yo have soemone with you? All these things can affect your success rate.

Hang in there and don't get discouraged.

 

Rhonda Wojtas

Rhonda Wojtas, RN VA-BC

sandy Collier
Thanks Rhonda, We are using

Thanks Rhonda,

We are using the Bard ultrasound. Very soon we will start using the Sherlock as well.   We have had several PICC's go IJ, so the Sherlock should help with this problem.

One of the main problems we are having is after we access the vessel we obtain a good blood return, but unable to thread the catheter.  Any further suggestions would be greatly appreciated.

Sandy

Occlussion Rates seem to be a ongoing issue with the Bard Power PICCs.

Carol
We use the Bard Ultrasound

We use the Bard Ultrasound and have over a 99% success rate but Both I and the othe PICC nurse have been placing lines for over 3 years exclusively. I do not undersatand why you are having trouble threading the catheter once in the vessel unless you are accessing vessels that are too small. Another thing, are you leaving the introducer in place until the line is fully advanced? If not this would help greatly with advancing the line. We do this and then pull the introducer once the line has been fully advanced and we have no problems advancing our catheters unless the patient is stenosed or spasming, which then you have to be patient and inch the catheter in slowly but we rarely have that problem. I f the patient is stenosed you may find yourself having to move to the other arm.

Carol

Heather Nichols
   Sandy,       Do

   Sandy,

      Do not get discouraged.  Placing PICC's is not extremely hard, but it does have a learning curve you must come around, especially if you are using specialized equipment to place them, such as ultrasound, and a navigational device. If you are not using those things, they will make your life much easier, and your success and outcomes much better, so you should attempt to get them.

    Our IR dept here at U of L will not place a PICC unless we have tried first at the bedside, unless we have a really good reason not to.  We have about a 98% success rate now, but it did not start out that way.  I took me personally a good 6 months to a year to get really proficient.  It only took my partner about 6 months.  Some catch on quicker than others.  We have always used ultrasound.  We started out with a Site-Rite 2, and we bought a SonoSite a year or two later.  We have also used the Navigator navigational device for about 6 or 7 years now.  I do not think I could (or would want to) work without my Navigator, and I KNOW I couldn't work without an ultrasound.  These days it just does not make sense to not take advantage of the devices we have avaiable to us to increase patient satifaction and outcomes.  

    Take your time, and if you can, call in a professional to work with you and your team.  It is always beneficial to learn from someone experienced, but if you can't, just be patient, and get your hands on as much educational material as you can.  Good luck!  Email back if I can be of any further assistance.

Heather 

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

You said you just started to place PICC lines

Is this with ultrasound or by the old fashiohed excalibur?

Is someone precepting you?  I hope you have a company sending you a preceptor to guide you thru at least 6-10 sticks

Lastly the learning curve for usage of ultrasound is 50 insertions and that is well doucmented in the literature.  How many PICC lines does your facility do a year and how many RN's are you training.  I suggest limiting the training to 1-2 RN's until each of those RN's hit 50 insertions and than train more RN's

kathy 

 

Kathy Kokotis

Bard Access Systems

Gwen Irwin
In our early stages without

In our early stages without MST or ultrasound, we were about 85% successful of the patients that we attempted.  We were really happy with that!

Now, we use MST and ultrasound and tip locator.  We have a success rate of 98.4% success rate.  Most of the issues for the 1.6% are with threading to the SVC.

I agree with the statement that it takes about 6 months to get comfortable with ultrasound.  Some of the troubleshooting, just has to be experienced.  There can be so many variables.

We have always worked solo (except for orientation of new people).

 Hope this helps.

Gwen Irwin

Austin, Texas

Carole Fuseck
Sandy, You may already have

Sandy,

You may already have heard this but make sure your needle/introducer is completely inside the vessel.  Also be sure that your don't accidentally pull back on the needle as you reach for the wire or other equipment. 

Our initial success rate was (gulp!) 30% with direct-puncture back in 2003.  After adding U/S, and more importantly -- after more education and experience, we are consistently over 92% success. 

Don't be too hard on yourself.  Good luck. 

Carole

CherylFerraro
When our IV team was first
When our IV team was first asked to do piccs the boss was trained and we piloted. They all went in the AC which obviosly did not go over well. Now radilogy does them but I think there is some talk due to the workload they have with piccs and all the other stuff they do, it may some day go back to the team with ultrasound imaging.

Cheryl Ferraro, RN

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