Any tips for a new PICC team?

[EHRN]

We are a fairly new PICC team, and would love to get some input from other teams out there. What works and what doesn't? Do you get any specialty pay? Do you get paid by insertion? What do you do if the MD refuses to read the chest x-ray and the radiologist has gone home? What hours do you take call? Do your floor nurses administer Cathflo or is it just your PICC team? Do you routinely use Statlocks or do you suture? Any advice is welcome

[iluvivt, BSN, RN]

I have been a member of a PICC team since 1989. As a matter of fact we were the first team to place PICCs in Northern California. Before teams a few speciality RNs were placing them. Years ago we started out with only a single lumen PICC and there was no microintroducer or Ultrasound. We had to get a 14 Gauge in to get a 4Fr. in. I will try to answer your questions.

1. Since we are employees of the hospital we do not get paid by PICC insertion nor is the patient charged for the insertion if they are an inpatient. They do however get charged for the PICC kit.

2. We operate 7 days per week from 630am to 8pm. We do not do on call. What we do instead is triage our orders. We do them by order of clinical importance and need. If we get too many orders in one day we place peripherals to sustain the patient until the next morning. On rare occasions an MD will place a CVC during the noc shift.

3. Suturing is no longer considered the optimal securement method of choice. The patient often gets skin irritation or infection at that stitch site and it is very difficult to clean. On rare occasions I will use it but use nylon rather than silk d/t lower infection rate. We use the stat-loc,a TSM dressing,Biopatch at site and Hypa-fix. Our team insists on doing the weekly cap changes and all dressing changes unless there is an urgent need when we are not there. Studies have shown that a dedicated team performing CVC dressing keep the infection rate 25-30% lower. That is huge.

4. We are certified to view and release our own chest X-rays, Check with your state BON and see if you can do this .There is a process that each facility has to go through. If you can not or do not do this you can not release the film until a radiologist has confirmed tip placement and you have completed any recommendations for repositioning

[iluvivt, BSN, RN]

oops forgot two

5.MDs do not like to officially read CXrays for liability reasons,but some will.

6. We have certified some non-IV nurses to administer Tpa,but without this training a lot of nurses were pushing too hard,using incorrect syringe size and they were making holes in the PICC. The best advice I can give you is prevention. Train the nurses how to properly flush especially after a blood draw