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Klugdon
Training for ultrasound used for IV access and PICC lines

Our hospital has recently purchased two portable ultrasound machines. We now are in the process of getting our PICC nurses and IV therapy nurses trained our question is what level of training do we need is" see one do one teach one" accetable or should we have someone certified in teaching ultrasound come in and certify the group? What are other hospitals doing in this area to certify their staff

Thanks Kevin

lynncrni
There is no "certification"
There is no "certification" process for any procedure. This is a misused word. But see one, do one, teach one is definitely not adequate in my opinion. You need knowledge and skill and this will require some form of an organized education process. This usually comes from the product manufacturer. Lynn

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

Alma Kooistra
I'm smiling a bit as I

I'm smiling a bit as I recall my ultrasound training.  We had a couple people come from another state (no license in my state so no touchy the patient) who showed me how to turn the US on and stood at the foot of the bed while I did my first insertion.  They coached me a bit on how to drape and apply the sterile transducer cover and essentially encouraged me while I did my level best to find the patient's basilic vein.

That was it for me!

I went through months of agony trying to figure out how to get proficient with ultrasound (the PICC team at our facility was ME!) and I got my best support from responses to my queries sent to the IV listserve (Margy Galloway and Doug B were the best!).  My success rate was consistently good but I went from being a one-poke PICC inserter to being mostly a three-poke person.  I just wasn't very efficient.

That was all about a year and a half ago and now I can smile at all those agonizing moments.  But I sure don't recommend doing it that way!

We have recently been adding to our team, and this week I was able to bring a staff person from never having touched a PICC line all the way to 100% successful placements using ultrasound within 3 days.  Obviously I'm still walking through this with her, but it only goes to show that there is no substitute for having an experienced person at the bedside with you.  That's my best recommendation.  However long it takes to get somebody trained may vary, but you'll get your best team member if there is someone with experience standing by. 

We have our PICC team members take the on-line course offered by BARD and then I have a 3.5 hour classroom session (case studies, tips for placement, a bit about complication management which builds on what was previously learned during the on-lline class and a practicum).

That seems to work well for us!

Alma Kooistra RN CRNI  

lynncrni
I hope Alma's trials and
I hope Alma's trials and tribulations are not common, but I feat that they are when no one in  your facility already has this skill of using US. A nurse from another state is quite common when doing bedside coaching but it is not only the lack of a state nursing license that limits this instructor's ability to touch patients. A nurse being paid by a manufacturer should only be in a coaching role without any actual hands-on patient care. When I started with a manufacturer I was told that even palpating a vein was crossing the line. So the instructor has to develop ways to verbally coach and advise without touching the patient. Also, the hospital would never allow a non-employee and someone not from a contracted organization to touch patients. So there are actually many reasons. So glad you made it through and have your internal training program now! Lynn

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

Daphne Broadhurst
I strongly encourage you to

I strongly encourage you to speak with your ultrasound rep to request education- from a nurse who uses ultrasound! When we purchased our first 2 machines, the sales rep came in & showed us basically how to use the buttons. As you can well imagine, the machines sat in our office for many months due to insufficient training. I was fortunate enough to attend the ultrasound workshop at AVA last year & then embraced ultrasound. The u/s manufacturer then brought in a sonographer to give us a more in-depth inservice- but still no hands on demonstrations so very few of the team felt confident with the devices & continued blind sticks. We then purchased 4 more machines but insisted on nurse-led education & built this into the contract. A nurse came in & provided a 4 hour theory session, then went to the bedside with us & instructed us on how to use the ultrasound. We had originally planned to have the instructor train 2 nurses who would then train the remainder of the team; however, we were all too keen, so she observed each of us performing 1-2 insertions & we then worked in pairs until we assessed ourselves as being confident & competent with the procedure. (I think I have a copy of a competency validation form that I developed-at the office. Let me know if you'd like to see it- email me at shseca[at]yahoo[dot]ca.) I'm thrilled to say all team members are proficient with ultrasound now, having had the proper training.

This is a long-winded story to say you have to have proper education to make this successful. There is a significant learning curve with ultrasound- I'd recommend at least a week (2 if it's not too pricey) with a trained nurse inserter or you will likely go through a stressful learning period, similar to Alma's & ours.

Good luck & be patient with it. You'll quickly love ultrasound! Ultrasound-imaging guidance absolutely has to become the standard for PICC insertions!
Daphne

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

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