We are recently proud owners of Phillips portable U/S to place our PICC lines. Still have to have the teaching/ instruction on both the machine and new way of insertion ( did regular stick in the A/C using Groshong or BD catheters) Our choice will be probably between Arrow or Bard. Does anyone want to share any stories of how they started? We are a 175 bed community teaching hospital ( Family Residency program )and busy trauma Emergency Center. Our main focus was vascular access in ALL areas/ units and central line dressings/trouble-shooting. Over the years , the number of PICC's we could place at the bedside dwindled to almost nothing as the veins got harder to find and we knew the standard was really to use U/S. There are 5 of us, only 1 per shift , days and evenings ( no 11-7 coverage). We do work 7 days/week including holidays. Our Interventional Radiology docs only generally place lines Mon thru Fri probably from approx 7am to 7 pm , occasionally staying later if there are late add-ons. They are VERY happy we will be taking over so to speak. We know it's going to be a steep learning curve until we are competent. We also worry about our peripheral patients being "stuck" many more times for successful placement if we aren't available. Can anyone share some encouragement,or thoughts on how they ensured a successful nursing PICC program at their hospital . Thanks in advance , Patti
accidental ditto. oh yea, and congratulations! enjoy your new equipment, may all your sticks flash on the first try :)
do you or anyone on your team belong to a local INS or AVA group? You might want to start making those connections if you haven't already. Local folks with experience can be a great help.
That is great Patti! I could make a few suggestions (how I got my experience using ultrasound). Can you get permission to observe at another facility where they are already using ultrasound? I think it is important to watch some experts doing it first. Maybe you can watch your radiologists. Next I would ask the ultrasound tech to watch you do a few of your first sticks if the radiologist doesn't have time. That was really helpful to me when I was first learning. Also try to find an online course that will teach you the principals of ultrasound and how to identify the structures in the arm. Your administration needs to commit to your training. which means extra staffing for a while. This is a skill that must be developed as there is a bit of a learning curve.
Spend a lot time of playing with the ultrasound scanning veins using your non-dominant hand because that is how you will do the procedure. It would also be a good idea to get a vein model such as the blue phantom to develope your hand eye coordination to track your needle to the vein.
You have to be patient with yourself. If you have ever played video games you will have an advantage. I find training gamers goes much quicker as they are adept at looking at a screen and not at their hands.
Once you decide on your catheter vendor they should be able to help provide some support at well.
Good luck.
Darilyn
I would highly suggest having education thru the vendor. The company that the unit was purchased from should provide education on how to use it. From a personal standpoint, we have been using Bard catheters as well as their ultrasounds. There are 5 hospitals in our system, and Bard has been very accomadating in providing both an on-line course as well as a full day course for PICC overview. Additionally, the second hospital is now utilizing the 3CG system for tip confirmation and Bard has had a clinical person here for almost 2 weeks to help the staff get comfortable with this product and to be profecient. I can't even imagine doing this without their support. Hopefully you will find the same type of support. Good Luck!
Janine Pritchett, RN-BC, BSN, VA-BC
Clinical Educator - Vascular Access
Congratulations on your new US. The learning curve is steep but the vendor should help you with that. You asked which vendor for PICCs are recommended by the group and I would suggest that you should look at both. Bard and Arrow provide excellent support for their products. The catheters are very different. We moved to the Arrow PICC for several reasons. There is no large reverse taper on the Arrow PICC which is an advantage in DVT prevention. The soft distal tip is also a design advantage. Arrow has an antimicrobial/antithrombotic catheter in a single lumen and soon to have a dual lumen antimicrobial. Our patient population has really benefitted from this catheter so I would suggest you look at it carefully.
The Swedish perspective.... is not that different. We started out from scratch 2 years ago. We decided to use BARD products. BARD europe has helped us alot with support and finding litterature. Here are my tips: Use your US machine as much as possible. I use it in any "difficult access", PIVs, taking blood samples, looking for thrombosis and ofcourse PICC. There is a lot of information about vascular US on the net. I have learned alot from you tube. You have to be the expert! a lot of pepole say that it is cheating, and ok you have that machine and bla, bla, bla. The patient comes first in my opinion. Our PICC team works from 07-16 mon-fri and sometimes during evening shift - nigth shift
Nurse specialist ICU/ANE/PICC.
Dep. of Neurosurgery
Umea University Hospital/SWEDEN
Congratulations on your new aquisition of an ultrasound. I learned to do PICCs using an ultrasound so I have no idea of how to do it any other way. That being said, once you get through the learning curve of using the ultrasound to identify the veins and guide your needle, I think you will love it. Anything new is a challenge.
Almost a year ago we upgraded to both Sherlock/ECG technology, and now we don't know how we ever did without it although we are still learning. We are overcoming difficulties we never could before and it has been a real brain challenge at times to decide what we are seeing on the screen and what to do to get that tip where we want it to go.
We are using Bard at the moment but Arrow has a great product too especially with their coated product that reduces infection and DVT. Look at both and look at the studies.
Best wishes to you. And to agree with Jill, "may the flash be with you".
Mary Penn RN
Vascular Access Team
St Charles MO
Welcome to the world of seeing what you are doing!!! Give yourself a learning curve...scan anyone who will sit still. I would grab physical plant/residents/students...just to get view vs technique vs variations in presentation. Don't stick...just do a complete vein assessment and see what you can and can't see! Picking different body frames to scan is a must!
Good Luck on your "Shades of Gray" journey.
Thanks for everyones advice ! We know we have to have the U/S training to learn the machine, that is already scheduled. 4 of the 5 of us are CRNI's and belong to combo of local /national INS.We are leaning towards the Arrow catheter and they will give us clinical support and a full education day for the new technique of insertion. ( I can't even begin to think about the ECG guided tip placement , my heart is already skipping a beat ) One of our I.R. docs will be our preceptor here and they are encouraging us to come watch insertions when we have time, I think they are so anxious to give this up, or at least as many as they can, that they will be very helpful.But I really wanted to know how you sheduled your hours and RESPONSIBILITIES. We have 175 beds, 1 IV nurse on each shift days/ eves, 7/365 . In the beginning did you have 2 nurses doing the insertions together until each became comfortable? How did you make the floors aware that you were not available so they wouldn't be overhead paging you? I'm reading some of the answers to the vascular survey questionsthat have some interesting info. We DON'T really want to do call, but realize it may be necessary. Glad to see other facilities only offer service Mon. - Fri. which is what we were hoping to do ( our IR rarely does them on a w/e ) We want to be professionally accountable to provide the very best program we can but worry about our patients who need peripheral IV's and rely on our expertise in caring for their central lines. Seems like we will be giving up a lot of that to be hidden under a gown and facemask placing lines...
Considering I initiated ultrasound guidance for nursing PICC line insertions starting in 1999 I would say this makes me an expert on learning curve. You will find artiles on starting PICC teams and cost containment under my name. The learning curve varies and is not easy. If it was so easy all MD's placing CVC's would be using ultrasound and they are not. For some the curve is as short as (10) insertions but that is not the norm. You get a good feel for it at 25 but you do not master it until 50 successful insertions. The lightbulb per see goes on at 50. Precepting is critical and I mean critical. IR MD precepting is not always the best in my opinion. I feel a skilled nurse is the best to train a skilled nurse. I usually have a nurse work side by side for 3-4 insertions per day for a straight week and than let the one nurse on their own for a week. AT this point I bring a preceptor back for an entire second week of training. This is how I would train a virgin team. It may take three visits/three weeks for one to two nurses to get it mastered. I cannot emphasize that the learning curve is not short any more than this. It can be frustrating and not at all like landmark placement. The nurse who has been precepted properly hits in the eighty percentile in success by the end of 25 insertions but can take to 50 to hit in the high 90's.
Do not be discouraged. Phillips is not a machine that has much of a marketshare for nursing placed PICC lines so I have not very much experience wiith it. They are not likely to have a nurse preceptorship program. I would find an instructor that is familiar with this machine. The majority of nurses use sonosite or siterites so get a good preceptor that knows this mahcine. Interveiw your preceptors to be honest in my opinion from all the PICC conpanies to make sure they know how to use this actual machine.
congrats on your machine
Kathy Kokotis RN BS MBA
Bard Access Systems