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Jessica Newsom
Vascular access team responsibilities

Hi everyone,
I work in a 150 bed facility. We currently have a Vascular access team which is available from 0800-1800 in house and on call for PICC's from 1800-0000. Our vascular access team is currently in a trial to collect data to see if expanding our hours to 24/7 coverage is needed. Currently, there is a vascular access nurse available 24 hours during this trial. We have found that usually after midnight things slow down quite a bit. I am wondering what other vascular access teams do and the hours of "operation."
I am also wondering if other teams manage the PICC dressings throughout the facility. In my facility the primary RN is responsible for changing the PICC dressing. During this trial we have found the CVC/PICC dressings to be loose, overdue, soiled, etc. I am starting to believe this may be an area that our team should manage, any suggestions?

Thank you,
Jessica, RN, VA-BC

nakayamab
nakayamab's picture
 Aloha, Jessica!

 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. 

Jessica Newsom
Thank you for the input! :)

Thank you for the input! :)

Jessica Newsom

nrosche1
 I work in a 191 bed facility

 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!

Jessica Newsom
Thanks!

Thanks!

Jessica Newsom

nurseatom
nurseatom's picture
VAT responsibilities

 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

mkcrowe01
 We are just a shade larger

 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

 

Jessica Newsom
Thank you for your input,

Thank you for your input, very interesting!

Jessica Newsom

MarkCVL
Consider trialing SQ

Consider trialing SQ securement as a possible solution for your migration issue. Regardless of who does the dressing...your line in more secure in the position you established it, at time of placement.

MarkCVL
Consider trialing SQ

Consider trialing SQ securement as a possible solution for your migration issue. Regardless of who does the dressing...your line in more secure in the position you established it, at time of placement.

lynncrni
 Here I go again on my soap

 Here I go again on my soap box about our use of terms. Tip migration is only the tip moving. Dislodgment is the catheter retracting out of the vein. An engineered stabilized device will/should reduce dislodgement but they would not have any effect on tip migration. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

kevinmcl2003
NOT an emergent procedure

When did inserting PICC lines become "EMERGENT PROCEDURES?" A PICC line is for stable, reliable long term IV access. If a patient requires emergent access then they need to be transferred to a higher level of care such as the ICU and the physicians should place a central line. Where did the notion of PICC lines being emergent procedures come from anyhow?

We are a 500+ bed university hospital spread out in two locations. We have a PICC team of 4 RN that work M-F 0700-1730. That's it! No PICC lines after 5:30pm. If your team plans ahead there is absolutely no need for evening or round the clock PICC coverage. We insert approx. 250 PICC lines per month with NO WEEKEND coverage.

I am very curious for anyone to please describe for me the circumstances where a PICC is "emergent." I appreciate your thoughts.

mkcrowe01
 My arguments to the c-suite!

 Edited got deleted sorry..

mizjaye
Jessica, The facility where I

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.

Jessica Newsom
Thank you for your input! I

Thank you for your input! I agree CLABSI's are everyone's responsibility however, it seems the vascular access teams/professionals take them a little more seriously! ;)

Jessica Newsom

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