PICC Lines in Radiology

I do have a question, does anyone have specific criteria for maintaining competency? How many a year do you have to do to stay competent? Does it include the use of the ultrasound machine use? Or, is it once you are certified PICC RN is OK from then on? Does that PICC certificate expire? I am new to this and still researching the issue. I am an angio RN and now the department is looking into letting us do the PICC lines in Radiology.

Hello, I'm part of a 3 member team...We are the Rad nurses and the PICC team at our hospital. Two of us have ER/CCU experience and one OR experience and have been nursing for >30 yr each. We feel we have very good IV skills, nursing skills, common sense and we know the staff and docs very well. The reason I'm mentioning all this is because this is what sold two of us to administration. ~6 yrs ago we found ourselves running from CCU to Radiology to sedate someone who was anxious /painful and having a procedure done. Then we asked ourselves, "how can we sell ourselves into having a job in Radiology". We were constantly finding ways to show them what an asset we are to the department. To make a long story short, they hired the two of us...We started right away writing standards and policies; helping with safety issues and making it known that having us there will make life easier in every way. We started off part time, one person on a day, then it got busy enough to have one full time and the other part time (we overlapped our schedule to cover the busy times). Then we got stats together on how the hospital could save money and increase patient satisfaction if they sent us to PICC class instead of having outside nurses come in to do the few piccs that were ordered. We sold ourselves again. That was 2 years ago. We went from a couple of PICCs/mth to ~10-30/mth by marketing our team to both the physicians and the nurses...teaching everything (but insertion) including how to be proactive for your patient. We've since (one yr ago) hired our 3rd team member who was sent to PICC class 6 mths ago. We are getting ready to do more teaching (for the docs, nurses, home health care and nursing homes)...the more they know, the easier it will be for them to order/take care of PICCs. We have a 'sort of' office down in Radiology (desk, phone, computer, files, in box, etc...), we have revised most of the Radiology P&P, written all of the PICC P&P, written/revised the central line P&P and written/revised the moderate sedation policy, we have a small Radiology dpt...we do about 2-3 liver/lung biopsies/week; start all the hard CT IVs, cath the VCUGs, assist with neph tube placement, abscess drainage, do all of the Portacath lab draws in lab, manage all of the things needed pre and post procedure (including calling the pt pre and post) and start all the other non CT IVs...we are anxious to start back with more interventional procedures but our Radiologists are going through a mid life crisis so anything really fun is on hold for a while. We cover from 0800 to 1730 M-F and now that there's 3 of us we each cover every third w/e for picc inserting or troubleshooting. We have a 'site-rite' US that we use when we put in our PICCs. We insert them all at the bedside. We are hoping that more marketing with the physicians coming up they'll be an increase in out pt placement which we do in the SSU. We hardly ever need fluoro but when we do the Radiologists are more than happy to help out (this is when we reach a dead end with the catheter and can't move it forward). We've also started injecting contrast/pcxr prior to taking them to fluoro just to get an even better idea of what venous mapping we're dealing with. We had an excellent teacher and were able to use their hospital's 10 member PICC team's P&Ps, competancies, troubleshooting/educational material, etc. as templates for our smaller hospital. We have annual requirements, signing each other off, we have many quality checks that are given to our quality assurance dpt, we have very good safety checks that gave us a thumbs up with being credentialed, we went to class to learn how to read our tip placements (the radiologists still have the final say). Our goals are to have all 3 of us certified in infusion and radiology nursing.We have a zero infection rate with our piccs...we have a standard prior to the picc being removed if they suspect cath related infection. We are proud of what we've accomplished because we, personally, took a lot of time to make it work and there is so much yet to learn!

I am a DI nurse in Florida. There are five nurses in our Radiology Dept. all of whom insert Picc lines. We use the Modified Seldinger technique. Our PICC lines are placed without a Radiologist present. The placement is confirmed by a Radiologist prior to Picc line use. We use ultrasound guidance always to place the pick and prefer fluoro to confirm placement and to correct any problems such as the picc line looping, or going to the wrong place and can be easily corrected. If the patient is in ICU we will place the Picc line at the bedside using ultrasound but a portable CXR is used to confirm placement. This is much more difficult because you do not have the real time view of flouro and if there is a problem with placement multiple CXR may be needed and any problems are corrected blindly. The Picc is usually completed but occasionally the pt may need to be taken to DI for fluoro. This also takes longer because the film has to be taken to DI for developing and then shown to the radiologist for approval. We are assisted by a specials tech 90% of the time because they are the ones who know how to work the fluoro. If done at the bedside we are assisted by a XRay tech or another DI nurse and a PCXR is called for. Our Hospital sends the DI nurses to a PICC class that is required but you recieve a certificate stating that you completed the class but not an actual certification such as a CCRN would get. I hope that this information is helpful to you.

We are just starting to have nurses do Picc lines at out hospital. We use ultrasound and Bard Kits Where did you get education otherthan what Bard provided?

We have the technologists fluoro for confirmation,prior to cxr

I am currently employed in a community hospital that has experienced exponential growth during the past 5 years. As a result our existing site rite assisted picc team can be overwhelmed and although our success for bedside placement is greater than 98% some patients require additional fluoro for placement. I would like to know what if any practice regulations there are fro nursing inseeting PICC's under fluoro? Can we do this? is there any existing arrangements whereby a radiologist must be inthe room at time of fluoro. I am sure there is implications for billing as well. I would greatly appreciate anyones time and input regarding this query as we try to amalgamate skills in this area to provide optimal patient outcome cost effectively. Look forward to hearing. I curently practice in NY state.
Drewba

I was curious about current medicare reimbursement standards involving PICC line insertion. I am a RA in Texas if some of you are unfamiliar with the acronym (its relatively new) it stands for Radiologist Assistant and its an advanced practice designation of Radiologic Technology. It requires a Masters in radiology, a minimum of 500 invasive and noninvasive procedures ranging from tunneled dyalisis catheter insertion to myelograms with competency being determined by attending radiologist. There are many other educational requirements that I will not bore you all with. It appears that with my educational background I am beyond my scope in the eyes of medicare at least in regard to reimbursement for PICC insertion. I am not trying to pick a fight, I promise. Scope of practice is not deffinative as to what a individual has the knowledge or abillity to do safely. It is beuacratic hyperbolle and nothing more. One of the posters mentioned injecting IV contrast pre-flouro, don't do that if the catheter was extra-luminal it would be a big blob not a venous map, waiting until flouro is available would be much more beneficial and less risk to the patient. I also noticed a few people mention technologist were present because they knew how to run the imaging equipement. That is true but more importantly because they are licensed utilize intentionally generated radiation for medical purposes. Nursing is one aspect of medicine its important that all the others are also respected we are all on the same team. I have the utmost respect for RN's and sincere love for your dedication which is most likely why I married one. Thanks A P

When a RN places a picc line they can not bill for the proffesional aspect of the procedure. Currently only MD/DO/NP/CNS/PA can get a NPI which is used for billing for the proffesional component. The facility may be able to capture the technical fee I am unsure about that though.

Many places can save $$ by having a RN place a PICC line espeially for long term needs. Having to replace IVs every 72 hours or more frequent eats up a lot of time and supplies.

There are some RA programs that are still a post bac level but most are going to graduate level education.

Jeremy

J, thanks for the insight on reimbursement . I freely admit medical reimbursement is not my strength. The clarification that your explanation provided in some respects created questions in other respects. I know of many PICC agencies that are comprised solely of RN's. In a hospital setting the argument could be made that the RN is working under a physicians license. That is not the case with agency PICC services the RN's function as independent practitioners. The Board of Nursing indicates that PICC insertion is within a RN's scope of practice. Ethically speaking should the Nursing board contradict the department of health and human services designation of who is licensed to safely place PICC lines. A hospital cannot bill for technical cost in a procedure performed by a Non-licensed person (non-licensed refers to medicares policy for professional charges). If a hospital charges specific technical fees for a Professional service they have to have the qualified professional doing the procedure. I have a very good friend that does pick lines full-time with a agency he is a RN. Last year he made 120,000 logically It doesn't make sense that the hospital will happily pay very good money for a service that they are not going to bill to medicare. Seems like a fraud bomb just waiting to happen. While PICCS are realitively safe procedures they do indicate enough risk to required the patient be given informed consent. Currently a RN is not licensed to obtain informed consent in Texas, how is this obvious impossible situation resolved without a MD, DO, etc. present. Even if they were available I doubt many would get consent for a procedure that they were not performing. Thanks Everybody Happy Holidays.

A P

HELLO, I realize this might be an old topic but I am a radiology Nurse In Oklahoma and the hospital just introduced the idea of making me the PICC placement nurse also. I am thinking, is this a full time job? Should I be certified or just trained. What would be the responsiblities under this title? Could you give me some insight please?