PICC Lines in Radiology

nurhmb · Nov 4, 2004

Tell me about your position. What hours and days do you work, who is your back-up, how are patients referred to you and by whom, how big is your hospital? We are discussing a PICC nurse to place piccs with US or flouroscopy as needed. How many do you place, say, a week. Who is your boss?

PICC chic · Nov 4, 2004

Tell me about your position. What hours and days do you work, who is your back-up, how are patients referred to you and by whom, how big is your hospital? We are discussing a PICC nurse to place piccs with US or flouroscopy as needed. How many do you place, say, a week. Who is your boss?

I am a full-time PICC nurse, I place all my PICC's at the bedside using u/s. I average about 70-80 successful placements a month. Very few I am not successful at. I work Monday-Friday. I get here around 0730 and stay until all my PICC's are done. I also help with difficult IV sticks, perform dressing changes, keep in touch with all my patients that have been discharged with their PICC or had it placed as an outpatients. I do call every other weekend. Have back up for the other weekend and any time off I may need.

I report to the CNO of the hospital. I hope this gives you a little more info on what your looking for.

cab631 · Nov 5, 2004

We are in the process of beefing up our PICC abilities hospital-wide. Right now there are a few nurses, hospital certified, who are placing the PICCs at the bedside, confirmed by STAT port CXR with a wet read. If we cannot get it in after two tries, then the patient is sent to radiology and the radiologist/nurse team place it under fluoro. One of our biggest problems right now is educating physicians on appropriately ordering PICCs. If a nurse calls him on a Friday afternoon with the fact that a patient is a "difficult stick"and they havn't been able to give Abtx or draw blood, to avoid being called over the weekend, the MD will order a PICC line. Never mind that it may not really be necessary if a a good IV nurse could get the line in to begin with. We have to IV team here. Any suggestions here?

nurhmb · Nov 5, 2004

We are in the process of beefing up our PICC abilities hospital-wide. Right now there are a few nurses, hospital certified, who are placing the PICCs at the bedside, confirmed by STAT port CXR with a wet read. If we cannot get it in after two tries, then the patient is sent to radiology and the radiologist/nurse team place it under fluoro. One of our biggest problems right now is educating physicians on appropriately ordering PICCs. If a nurse calls him on a Friday afternoon with the fact that a patient is a "difficult stick"and they havn't been able to give Abtx or draw blood, to avoid being called over the weekend, the MD will order a PICC line. Never mind that it may not really be necessary if a a good IV nurse could get the line in to begin with. We have to IV team here. Any suggestions here?

The Friday afternoon PICC seems to be a common problem. Unless you have a 24/7 team, someone has to hang into Friday night etc. We are looking at admission criteria (Atlas Computer Program) that might ID patients who should have PICC from day 1 because we know that they will have prolonged IV's...osteos and such .....in order to id some of these people earlier in the admission and the week. I don't know if we would then approach the MD for the order or if there would be some kind of automatic ok obtained from the physicians so it was could be initiated by protocol. We are trying to figure out how a smaller hospital maintains more than one position and back-up for PICC insertions and what "the rules" need to be on this to be the most effective for patients but also the PICC nurse. Physician education is a huge issue. I have made a joke that one of the critieria for a PICC should be the physician does not want any pages. If we put that as number one, we would get everyone on the day of admission. :)

PICC chic · Nov 5, 2004

We are in the process of beefing up our PICC abilities hospital-wide. Right now there are a few nurses, hospital certified, who are placing the PICCs at the bedside, confirmed by STAT port CXR with a wet read. If we cannot get it in after two tries, then the patient is sent to radiology and the radiologist/nurse team place it under fluoro. One of our biggest problems right now is educating physicians on appropriately ordering PICCs. If a nurse calls him on a Friday afternoon with the fact that a patient is a "difficult stick"and they havn't been able to give Abtx or draw blood, to avoid being called over the weekend, the MD will order a PICC line. Never mind that it may not really be necessary if a a good IV nurse could get the line in to begin with. We have to IV team here. Any suggestions here?

It took a lot of training and support from my CNO to make the Doc's and the staff aware that PICC's are not done after 5pm. Granted that by 4:00pm I may still have 3 picc's to do, and I stay to do them. Anything after 5:00 gets placed the next day. PICC's are not an emergency! If the patient is doing that badly then a central line should be placed.

Case Management is a good way to capture pts that are going to be dc'd with a PICC as they are the ones that are setting up home health. It is appropriate for the PICC nurse to say that this person can get by with a peripheral. I ask the staff here to call me first for difficult IV sticks before they call the MD, because he will surely order a PICC.

It is a difficult job to get staff and docs to be proactive instead of reactive when it comes to IV therapy!

nurhmb · Nov 5, 2004

It took a lot of training and support from my CNO to make the Doc's and the staff aware that PICC's are not done after 5pm. Granted that by 4:00pm I may still have 3 picc's to do, and I stay to do them. Anything after 5:00 gets placed the next day. PICC's are not an emergency! If the patient is doing that badly then a central line should be placed.
Case Management is a good way to capture pts that are going to be dc'd with a PICC as they are the ones that are setting up home health. It is appropriate for the PICC nurse to say that this person can get by with a peripheral. I ask the staff here to call me first for difficult IV sticks before they call the MD, because he will surely order a PICC.
It is a difficult job to get staff and docs to be proactive instead of reactive when it comes to IV therapy!

I agree that a PICC is not an emergency intervention. I am assuming that you do not do PICCs on weekends. What are your Mondays like? How big is your hospital? Are you doing the 24 hour and regular dressing changes consistantly? Who handles the Friday patients dressing management? What would you do differently if you started the program again? Your insights are helpful. Thanks. :idea: :idea:

PICC chic · Nov 5, 2004

The census runs around 200, we do provide on-call weekend coverage but not for after hours. When I took this position, one of the first things I did was provide classes for the nurses on care and maintanence of PICC lines. I do try and keep up with the dressings, but some days I'm so busy inserting I don't have the time. Most to nurses are pretty good at getting them done if I don't.

I also assist with difficult IV starts, I also do a fair number of PICC's on out-patients, which acutally makes money for the hospital. Reimbersument is quite good. I track all blood cultures and central line infections and the dwell time of all PICC's, it the patient has completed therapy without complications or if it was removed due to complications. Which means that I make telephone contact with all patients who have been discharged either home or to a LTAC.

I compile the data into a quarterly report which administration loves! I look at it as good job security!

nurhmb · Nov 5, 2004

The census runs around 200, we do provide on-call weekend coverage but not for after hours. When I took this position, one of the first things I did was provide classes for the nurses on care and maintanence of PICC lines. I do try and keep up with the dressings, but some days I'm so busy inserting I don't have the time. Most to nurses are pretty good at getting them done if I don't.
I also assist with difficult IV starts, I also do a fair number of PICC's on out-patients, which acutally makes money for the hospital. Reimbersument is quite good. I track all blood cultures and central line infections and the dwell time of all PICC's, it the patient has completed therapy without complications or if it was removed due to complications. Which means that I make telephone contact with all patients who have been discharged either home or to a LTAC.
I compile the data into a quarterly report which administration loves! I look at it as good job security!

Are you just involved with PICC stats or do you also get involved with other central line stats? How many outpatient PICCs do you see, say, in a month (just curious). Your job sounds sort of like what we had visualized might be a full time position. Who does your back-up? You sound almost like a modified IV team of one. Your hospital is lucky to have someone like you with your skills who likes what she is doing. Your feedback is very helpful. Thanks.:balloons:

Tri4kids · Nov 5, 2004

Thanks for the replies, but I want to dig deeper...
ARNA (American Radiology Nurses Association) during their annual convention in March 2004 will be addressing the topic of establishing venous access teams. Should be a good meeting.
In the meantime, does anyone have any experience with RN's placing Picc Lines in Radiology without a Radiologist present?
When nurses use ultrasound- is an ultrasonographer required to be present?

Well this is a very HOT topic where I am from. I have been a Pediatric RN for 6 years and have fought tooth and nail to have RNs certified to insert PICC lines in our pediatric population without having to go to Fluro.

We have in years past had a couple PICC RN inserting line with poor success rates and the patients ended up in Fluroscopy. Our Fluro dept has a rule that any Peds patient requiring a PICC line must have previously unsuccessful attempts by the PICC RN, and then they will accept the pt AND ONLY the Radiologist will insert the PICC with Tech assistance. They do use a "ritesight" (ultrasound) sometimes but most of the times they only use contrast and xrays for Tip verification.

But now back to the RN placing PICCs. over the past 3 years I have been placing PICC without the use of ultrasound and now use a MICROINTRODUCER! Which has changed the world of PICC insertion in the pediatric population. We have 10 PICC RNs for Pediatrics (not including NICU PICC RNs) We have a 98% success rate for insertion and have decreased the number of attempts because the ease of the Microintroducer.

I can give you more information if you would like it. Hope this helps!!

-Dawn

Tri4kids · Nov 5, 2004

Well this is a very HOT topic where I am from. I have been a Pediatric RN for 6 years and have fought tooth and nail to have RNs certified to insert PICC lines in our pediatric population without having to go to Fluro.
We have in years past had a couple PICC RN inserting line with poor success rates and the patients ended up in Fluroscopy. Our Fluro dept has a rule that any Peds patient requiring a PICC line must have previously unsuccessful attempts by the PICC RN, and then they will accept the pt AND ONLY the Radiologist will insert the PICC with Tech assistance. They do use a "ritesight" (ultrasound) sometimes but most of the times they only use contrast and xrays for Tip verification.
But now back to the RN placing PICCs. over the past 3 years I have been placing PICC without the use of ultrasound and now use a MICROINTRODUCER! Which has changed the world of PICC insertion in the pediatric population. We have 10 PICC RNs for Pediatrics (not including NICU PICC RNs) We have a 98% success rate for insertion and have decreased the number of attempts because the ease of the Microintroducer.
I can give you more information if you would like it. Hope this helps!!
-Dawn

One more thing. The most important part!!! Sedation! In my personal opinion, no one not even adults should have to be anxious, scared or have sugnificant pain related to the insertion of a PICC line. So in addition to our peds pt's getting picc lines placed the success is due to two things: 1. an experienced PICC nurse with excellent IV skills and 2. a cooperative patient (that does not move during insertion) which is very difficult in children...so we schedule the insertion with our Sedation Team and our ChildLife department, together with distraction and either the use of moderate to deep sedation for the insertion we have become highly proficient and hugely successful in PICC in children. The use of sedation has so many benefits which ultimately out way the risks of the sedation itself and the pt experiences less trauma, decreased insertion attempts, successful insertion and the family is not stressed out!

-Dawn

PICC chic · Nov 5, 2004

Are you just involved with PICC stats or do you also get involved with other central line stats? How many outpatient PICCs do you see, say, in a month (just curious). Your job sounds sort of like what we had visualized might be a full time position. Who does your back-up? You sound almost like a modified IV team of one. Your hospital is lucky to have someone like you with your skills who likes what she is doing. Your feedback is very helpful. Thanks.:balloons:

I actually just track PICC's. The infection control nurse tracks other central line infections. I do about 10 out-pt PICC's a month. I would like to increase that number at some point by marketing, but the in-patients keep me busy enough!

I have a part-time nurse who takes call every other weekend and covers my days off(which are not many). I have to say that my hospital does truely appreciate all that I do!

Tri4kids · Nov 5, 2004

I actually just track PICC's. The infection control nurse tracks other central line infections. I do about 10 out-pt PICC's a month. I would like to increase that number at some point by marketing, but the in-patients keep me busy enough!
I have a part-time nurse who takes call every other weekend and covers my days off(which are not many). I have to say that my hospital does truely appreciate all that I do!

We have a CNS who helps track the infection control of our PICC lines. Unfortunately, my hospital considers thier budget more important than anything else. I am a floor nurse that wears Many hats. Sedations, PICCs, Procedures and anything else that may arise. But in Peds our outpatients will preschedule PICC placements as a Short-stay admission because most will usually require sedation then they get to go home after confimation with Homehealth followup. The number varies with the season's I usually do about 10-20 a month inpatient and out patient combined. You are very lucky to have a set schedule and actual position, our hospital just thinks I have a free open schedule...

YOU ARE VERY LUCKY!!! Keep up the good work:balloons: