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 Aloha, Jessica!

I work in a 300 bed facility that is an HMO. We have no VAD team. The infusion center nurses act as the defacto IV team. We have one PICC nurse for 12 hour shifts, from 08 to 2000, Monday through Saturday. We have no PICC nurse on Sundays. We do not manage the PICC dressings, leaving it to the patient's assigned RN to change every Monday evening and PRN. We do find them loose and soiled but this is the exception. Our management has always wanted the primary nurse to be responsible for their own PICC dressings. 

 I work in a 191 bed facility. We have 3 Vascular access providers. We cover M-F 7-7 and Sat/Sunday 9-7pm. We do all PICC placements, difficult IV/lab draws using USG, all PICC dressings, CVC consults, CVC dressings and port access/deaccess in units with very low CVC rate where RN may not feel comfortable with procedure/protocol.

We have found it valuable to do PICC dressing changes to monitor external length. I work with pediatric population so we also find it valuable when a provider that does PICC dressing changes regularly does them so it does not accidently get dislodged.

Good luck with th team expansion if you decide!

 Hi Jessica,

We are approx.. 500 bed tertiary care, academic, inner-city trauma center. We have a vascular access team who manages difficult IV access, CVC troubleshooting, midline insertions. We do not place PICC’s (hopefully to change in the new year), will draw labs for some in-patient units via CVC if they are not authorized. Our team works 24/7- we have 2 RN’s /shift (12 hours). About 2 years ago we only had one RN on night Thur-Sat due to cutbacks, however, we showed via our stats that the workload/responsibility was far too great for one RN. Sure, there might be slower nights where one RN would be fine, however, there too can be nights where there are more consults/requests then day shift.

Our team doesn’t manage PICC dressings as they are deemed a ‘routine nursing task’. This I disagree with, as on many (MANY) occasions we lose our PICC’s, or have to wait for an exchange as they migrate out (“Opps, it just fell out!”). Part of my proposal for our PICC team is to provide the care and maintance (including dressing changes) to ensure proper technique is followed, but to also track outcomes better.     

Hope that helps!

Adam

 We are just a shade larger than you, about 215 beds. We have similar coverage, 0800 - 1800, with 3 FTEs covering 7 days  [excluding NICU coverage]. We do have a contracted agency for the "emergent" PICC needs after hours, and have culture-shifted that to mostly after-hours midlines. We perform 85% in-house vs. 15% agency insertions. Our intensivist group, though, just hired night PAs to be in-house, 1 happens to have IR experience and does a heck of a great PICC insertion. System-wide, we changed from Statlock to another engineered securement device and had to replace WAY TOO MANY PICCs because of the migration out 5+ cm from insertion. We then took over ALL central line care and maintenance for the whole house. CLABSI rate dropped significantly, I want to say >5/year to 1/year. Staff are still accountable for PRN dressings after hours.  We also have a large oncology population whose oncologists want their ports used for outpateint CTs and MRIs, so we access & deaccess those, and the patients are very happy for dedicated staff to do so. We are not based out of IR. We also round on all lines - assess dressings, flush, blood return - ideally daily, in reality we see all lines maybe 2x weekly, but by doing so we've decreased complete occlusions (early intervention with Cath Flo) and change the dressings before they are really bad. On any given day, we have 40-60 CVC/PICC/Midlines/etc in house. We also took dressing changes away from the contracted dialysis agency as part of our CLABSI strategy, as we take the hit for it. The other nice thing about taking over dressings is you can manage the occasional patient with impaired skin, bleeding, oozing, etc. I've learned alot working with our CWOCN and have been able to save a lines in areas with compromised skin without compromising the line integrity (esp. in 3rd spacing patients).

Your best friend is the data. During your trial, are you keeping track of the dressings in need of a PRN change and the reason on a spreadsheet? Cold, hard numbers in black & white with nice graphs & pie charts go along way in the c-suite. Good luck!

Kathleen Crowe BSN RN CRNI VA-BC

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Jessica, The facility where I work our Vascular Access Team hours of operation is 24 hours/ day, 7 days/week with 3-4 RNs on dayshift and 1-2 RNs on nightshift and on weekends 2 dayshift nurses and 1-2 nightshit nurses. We probably have 200-250 beds. We place place PICCs, midlines, change the central line dressing, and insert peripheral IVs. Eventhough CLABSI is everyones responsibility, I think it is better for the IVRN to perform central line dressings because you are keeping track of when it needs to be changed and you are looking at the dressing on a daily basis.