PICC Lines in Radiology - page 3

by angiorn

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Are any radiology RN's placing Picc lines in their departments and if so are you utilizing fluoro or ultrasound guidance? In the instance that you are using fluoro, is it a technologist administering the radiation? What... Read More


  1. 0
    Quote from angiorn
    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:hatparty:
  2. 0
    Quote from Tri4kids
    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:hatparty:
    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
  3. 0
    Quote from nurhmb
    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.
    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!
  4. 0
    Quote from PICC chic
    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
  5. 0
    Does anyone have rad techs placing PICCs at their facility? We have a new employee who did this routinely at a previous employer, but we aren't sure how kosher it is. Thanks in advance.
  6. 0
    Quote from SWAT_RN
    Does anyone have rad techs placing PICCs at their facility? We have a new employee who did this routinely at a previous employer, but we aren't sure how kosher it is. Thanks in advance.
    You can check your state practice acts. Ours in PA say no.

    Here is my very biased opinion on this topic as a nurse in full time action for 27 years. This is an RN skill level procedure that involves assessment, intervention and patient education. Many things can go wrong and you need the advanced skills of an RN. Also, just because someone has a skill does not mean that the patient welfare is being met. Finally, why are you giving up RN skilled pieces that involve assessment, intervention, patient education, trouble-shooting and possible emergency care? Why are you saying that anyone can perform this task? When you give this up you are saying that RN's are not needed or necessary for complex medical care.....bad idea. You are disapaiting our respect and down playing the need for nurses to keep patients alive and well in our healthcare system today. (See the NIH research on this) Do you feel that anyone can perform this skill? Then you have not experienced the issues that can occur. Trust me. Your first crisis will support this opinion. Things can and do go wrong no matter how skilled you are in the process. Please think twice about even considering this option. HMB RN, MSN, CNS, Certified Nurse in IV therapy, long term PICC inserter and educator
  7. 0
    i am a staff memeber of the radiology dept - i do use ultrasound for location ot the vessel and i use fluoro to guide the length of the catheter and to be certain of its location before i cut the catheter.
    i operate both pieces of equipmen. i use the foot pedal to activate the fluoro as i need to, but the technician who turns on and off the source, is presnet while i work in case i need anything. the tech then takes the final photo from the control board after i place the catheter for documenation.
    the ultrasound i turn on an off myself (using sterile technique, sometimes i need them to turn it off while i finish the case), but we have a small unit just for this purpose.
    our credentialing is that the physician in charge of the radiology dept needs to observe our technique and check us off on our performance list that we made up for this purpose. able to demonstrate steile technieque, proper operation of equipment, and of course proper knowledge of picc line placement. it is a check off competency that we do yearly. i do enjoy doing these, at times a resident is present and they can do them also, so we often switch off to keep up our experience.

    :wink2:

    Quote from angiorn
    are any radiology rn's placing picc lines in their departments and if so are you utilizing fluoro or ultrasound guidance?

    in the instance that you are using fluoro, is it a technologist administering the radiation?

    what type of credentialling or certification is required at your facility/state?
    Quote from angiorn
    thanks!
  8. 0
    Quote from spirit-a-glow
    [size=3] i am a staff memeber of the radiology dept - i do use ultrasound for location ot the vessel and i use fluoro to guide the length of the catheter and to be certain of its location before i cut the catheter.
    i operate both pieces of equipmen. i use the foot pedal to activate the fluoro as i need to, but the technician who turns on and off the source, is presnet while i work in case i need anything. the tech then takes the final photo from the control board after i place the catheter for documenation.
    the ultrasound i turn on an off myself (using sterile technique, sometimes i need them to turn it off while i finish the case), but we have a small unit just for this purpose.
    our credentialing is that the physician in charge of the radiology dept needs to observe our technique and check us off on our performance list that we made up for this purpose. able to demonstrate steile technieque, proper operation of equipment, and of course proper knowledge of picc line placement. it is a check off competency that we do yearly. i do enjoy doing these, at times a resident is present and they can do them also, so we often switch off to keep up our experience.

    :wink2:

    i would be very interested in reviewing your credentialing check-list. i have been regularly placing picc lines for a few years now. i have previously worked in interventional rad, icu, nicu, finished my msn. our hospital has several picc nurses that all work full time in other jobs (no designated time or rn to do the job). we squeeze it into our other job time. our interventional rad docs don't want to do the job, and will only look at the patients after we have done a full assessment and tried placement. i have an information request out to our state board (co) and am trying to gather information/data to support nurse credentialing for picc placement by an rn under flouroscopy and the hiring of a full time picc nurse. thank you in advance for any help you can give me. :melody:
  9. 0
    Dawn;
    Will you please share with me a little more about the "microintroducer" and your success utilizing it. Thanks

    Quote from Tri4kids
    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:hatparty:
  10. 0
    some hospitals have a team of nurses that do beside PICCs but only into subclavian. mine doesnt. here PICCs are done in radiology "special procedures" the Rn circulates and documents while the RT assists. most RadMD's hate doing them especially on weekends. the tech uses us to find vein and mark it and then radMD will do the procedure. in our dept the only RN is the one working in specials. nuc med and ct techs all start their own IV's (except the lazy ones).


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