Increase PICC numbers

[HMarie13]

I just wanted to see other hospitals (similar is size) PICC numbers are. I am a 1 person vascular access department, I work bankers hours. We usually have about 250-290 patients in house. I am not trained on pediatric.

Last year I placed about 600 PICCs (average 35-60 month) and a little over 1000 PIVs. I am constantly being asked to increase my numbers...but HOW?!?!

When a PICC is ordered usually the only lab level that will prevent me from placing in the kidney function levels. The patient has to be on at least 2 vesicants. When I get a call for a PIV if it is not an emergency situation I assess the need for PICC first.

We have had our sales rep come in and talk with the physicians, I have talked to each group of our residents.

Please, any ideas would be great! I need to increase my numbers to keep my position.

[Asystole RN]

Those numbers seem extremely low to me, at one hospital I worked at with a bed size of 200 we averaged 1,000-1,500 PICCs alone, not including about 750 midlines and thousdands of PIVs a year. Granted, we were a rather large team but only 1 person was on any given day and we worked 10 hour days with call at night and weekends.

I would look into increasing the the amount of midlines and extended dwell peripheral IVs that you are starting.

After that rounding for routine PIV changes during down times and central line dressing changes. When we would round we would find an amazing amount of PICC candidates where the RNs or Docs didn't think to consider. I guarantee you that if you walked around and asked all the RNs on the floors that you could literally fill your entire shift with nothing but PIV insertions for that many patients.

In the 2011 CDC BSI Prevention Guidelines handwashing was only a IB recommendation while a dedicated IV team was a level IA. CDC would much rather have you start the routine PIVs and change the central line dressings than the floor nurses.

[HMarie13]

Those numbers are awesome! I just don't understand why our numbers are so low?!?! As far as I know even years ago when the nurse was "busy" she was placing maybe 800 a year.

I actually do currently do rounds on all central lines, offer to do PIVs, assess the need for central lines and removal of femorals. It usually gets me a little business but not much. The problem is that only part of my job that counts towards productivity is actual PICC placement.

Thank you for you information and advice! I will keep on and hope it helps!

[MikeyT-c-IV]

I like your question. I work in a hospital about half your size but I place about the same number

of PICC's that you do. In fact I think we placed about 690 PICC's last year and well over 1000 PIV's. It's just a personal/professional goal of mine to identify and intervene as well as I can.

So to answer your question. I, personally, start my day off by reviewing new admissions every day. I look at "key diagnosis" to determine if I want to follow up with the dr/nurse. I look at things like, osteomyelitis, cellulitis, UTI (especially in the elderly), pneumonia, etc etc. You catch my drift.

I am the type of guy who likes to stay very busy. I love moving on my feet, seeing as many patients as possible.... I use my experience and talent to help others. NOBODY likes being stuck with needles... but I figure, hey, If you gotta be stuck you want me to do it! hahaha

Most of the time our RN's and DR.'s will be fairly proactive in getting the PICC consult addressed. Occasionally I'll need to intervene. Usually it's an education issue... and you can definitely make a difference in that arena. :) Good luck!