IR *wants* to place PICC's.. now what??

[RN Randy]

Hello, just have a quick inquiry:

I live in a rural area and I'm interested in PICC insertion.

I'd be happy doing contracts.

I'd be happy starting PICC teams in a couple small hospitals and "make" myself a job.

I have access to several small hospitals, say 100-150 beds each.

ALL of them appear to use a contracted IR service that rolls in a mobile unit, once/twice a week or so.

The IR service does the PICC lines for the hospitals.

When I contacted the IR service, in regard to either employment/contract or to just get basic info;

they pretty much told me that they don't feel a nurse should be dabbling in the physician's arena by inserting central lines, and that if I thought I could take anything from them, to have at it.

Seems they will threaten to cancel their IR contract with the facility if anyone tries to muscle in on their turf, so to speak.

Yes, I just said they suggested they'll drop a multi-million-dollar contract over [the 100 PICCs] they claim to do per year.

And it does exactly what they want it to do. It makes the administration say "no, thanks, go away." when I approach the hospital about saving money.

Second problem is even worse... Contacting the local LTC and SNF operations netted this:

"Um, we mostly use LPN's and we certainly won't let them touch deep lines. Besides, why would a patient have a PICC outside of an ICU? Certainly not here."

So any advice on how to approach those massive problems?

It looks like a sewn-up, po-dunk, slam-dunk to me.... never gonna happen, unless I'm missing something really silly.

However; there is the hope of one city hospital that might be a candidate for a PICC team if I can show them how to make it work.

Any help appreciated!

thanks,

rb

[GailAnne]

When you say that you are "interested" in PICC insertion, do you mean that you are not currently trained? It takes anywhere from 40 to 100 insertions to feel really comfortable with all that can happen. Setting up on your own also means having an Ultrasound as well as the basic supplies. Many places put the person on the moniter, requiring you to have monitoring skills. Lots of issues that you need to address to be prepared.

The big issue for you may be, who will be your back-up? I've been inserting PICCs for years and still have the occasional person who must be done in radiology. Also, you need x-rays read in a timely manner. If the radiology docs are peeved at at you, how will that be done?

As for your comment re "something really silly", remember, the silly part here may be true....just not you, only the situation.

I'd say that the approach of going in well trained with a plan to one hospital will be your best bet, when other places see that it can be done locally, they are more likely to be interested. This takes years, not months though.

All the best

[RN Randy]

Hi and thanks for the reply.

Well, at the time, I was trying to find a way to get PICC's away from travelling IR guys. Most of our small hospitals use them. Hospitals all have their own Rad Dept, but not IR equipment. Hence, the roving road show.

I was in the process of training and trying to get experience. Not something easily done in an area where people routinely confuse PICC nurses for residents; as *just a nurse* wouldn't be doing such a thing.

You have to understand the mentality of local folks in the backwoods. At smaller hospitals, nurses still drop their charts and move out of the way when a doc comes in the nurses station looking for a chart or chair; and only when the doc finds what he wants and chooses a chair do they all then sit again. If someone doesn't notice; people will call their attention and point to the 'holy one', letting them know to bow out. It makes me ill just thinking about it.

So, when a doc; especially a high-dollar IR operation with their own truck says "we want" well, They Get.

As for PICC's, it's like any other skill; and you get out what you put in. I'm a quick study, especially on skills and equipment so it seemed a perfect fit for me.

However; when the hospital says "IR will pull out if we upset them and we need their service. We're willing to take the loss or pay the difference in PICC insertion, if it makes the IR guys happy.", then whatcha gonna do?

[JCKent]

One thing you can offer these hospitals is that you can provide skilled nursing care to these lines after insertions. I'm sure your IR guys stick, picc, and run. I can only imagine the infection and complication rates these hospitals are dealing with. Having a dedicated PICC nurse who works with all these lines and knows them inside an out in an invaluable resource. There is a great deal of documentation and research on IV Team development and successes.

I can not express enough how much education you need as well as continuing education on top of plenty of hands on experience to be proficient, competent, and safe. You also may want to look into earning your certification in infusion nursing from the INS. This will expand your education as well as give you more credibility.

Good luck. I am sure you can provide these hospitals with a superior service over their current situation.