On call PICC nurse? Does such a thing exist?

jmgrn65, RN · Jun 5, 2007

not in our area? at least not that I am aware of, well maybe Home Health.

withasmilelpn · Jun 5, 2007

We have sometimes contacted our IV on call team through our pharmacy. They place piccs and peripherals (if we can't) within about 24 hours of calling them. That's where I'd start looking, however, the pharmacies that service nursing homes may involve several facilities and some significant travel.

jannrn · Jun 6, 2007

I am in California and the small hospital I work in (we don't have phlebotomy or IV services) we contract with an outside company, one that also supplies medical supplies to homes. They have RN's who are certified and experienced in placing PICC lines who will come to the hospital to place them.

TheCommuter, BSN, RN · Jun 6, 2007

I work at a nursing home, and our PICCs are inserted by on-call PICC line nurses who are employed by the pharmacy that we use.

Our facility is billed $475 for each PICC line placement, so I assume that the PICC line nurses earn pretty good money.

CritterLover, BSN, RN · Jun 6, 2007

i'm currently a nurse in interventional radiology. we place picc lines (however the institution that i'm in currently does not let nurses do picc lines)
i want to get certified in picc line insertion. i was told by a coworker from my old job that there are nurses that are on call for picc line insertion. (for example for nursing homes)
how do i find out if such a job exists..(i'm in brooklyn ny) .i'd love to do this in my spare time... any info would be much appreciated.

that is my current job, though i'm leaving it soon.

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[color=#483d8b]i work m-f for a pharmacy. i place piccs in an outpatient center, in nursing homes, rehab facilities, in the home for home-bound patients, and in a small hospital.

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[color=#483d8b]i would highly suggest that you get some solid in-patient picc placement experience before you go out and place them on an on-call basis for nursing homes, etc. those are the toughest patients to get piccs into (due to comorbidiites such as renal insufficiency, pvd, diabetes, long-standing htn, etc), and the facility will have to pay your company even if you don't get the picc in. too many unsuccessful attempts, and they won't be too eager to use your company again in the future.

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[color=#483d8b]remember, you will be working blind, without the benefit of fluro. i do all of my piccs without fluro, and my success rate is somewhere around 96-98% for getting the picc into the svc. (we don't place midlines or midclaviculars, though midlines may be an option wherever you end up working.) however, that came with much practice. in the begining, i was only able to get about 1/2 in that i attempted. best to learn in a controlled environment, with radiology nearby, so that any unsuccessful attempt doesn't cause too much trouble. (what i mean by this is that in a nursing home, if you can't get the picc in, they then have to schedule the patient in some facility's ir dept, then schedule an ambulace to take the patient/pick the patient up, and pay for all of it. a real pain the the butt, and it can take several days, if not a week to get all of that scheduled. while in the hospital, it is merely an order to ir, and trasportation takes the pt down. shouldn't take more than a day or so, if that)

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[color=#483d8b]good luck. i'm told that a "roving picc company" is a good business for a nursing entrepreneurs. too bad i have zero business sense :) .

CritterLover, BSN, RN · Jun 6, 2007

i work at a nursing home, and our piccs are inserted by on-call picc line nurses who are employed by the pharmacy that we use.
our facility is billed $475 for each picc line placement, so i assume that the picc line nurses earn pretty good money.

don't bet on that.

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[color=#483d8b]when i go back to working in the ed, i'll be making roughly 20k more a year, and a lot fewer hours.

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[color=#483d8b]the kits we use cost over $250, and not all of the supplies we use are in that kit. some necessary supplies have to be added to it. not to mention the bedside ultrasound we use, a one-time expense, but it was over $15,000 when we bought it.

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[color=#483d8b]your facility is actually getting a really good deal.

Daytonite, BSN, RN · Jun 6, 2007

CritterLover is correct. It is mostly the large pharmacies that service nursing homes and home health agencies that employ nurses who insert PICC lines. When I was on an IV team all of us RNs were trained and certified to insert PICCs. We never did more than 2 insertions a day. We never inserted them during the evening or night hours. The home patients usually have way worse veins than most inpatients. Our facility policy was that no PICC could be used until it's placement was verified with an x-ray. We also repaired Hickman's and triple lumens. You can find training courses through the INS (Intravenous Nurses Society).

CritterLover, BSN, RN · Jun 6, 2007

critterlover is correct. it is mostly the large pharmacies that service nursing homes and home health agencies that employ nurses who insert picc lines. when i was on an iv team all of us rns were trained and certified to insert piccs. we never did more than 2 insertions a day. we never inserted them during the evening or night hours. the home patients usually have way worse veins than most inpatients. our facility policy was that no picc could be used until it's placement was verified with an x-ray. we also repaired hickman's and triple lumens. you can find training courses through the ins (intravenous nurses society).

no more than 2 piccs a day???? seriously????? wow...must be nice.

[color=#483d8b]typical day is 3-4. i've had many days where i've done 5-6. most i ever did was 9. (8 hr shift)

[color=#483d8b]of course, then i have days like today where i did zero. got caught up on my ceus, though.

[color=#483d8b]i do sometimes place them in the evening, but never truely at night (except once when i was working in the ed and they talked me in to it.)

[color=#483d8b]we, too have the policy that all piccs must be xrayd prior to use. we have a mobile xray company that does all xrays in the homes and facilities that don't have on-site xray capability. since i work in a state that doesn't allow rns to do wet reads, they have to wait for a radiologist to confirm placement before use. midlines don't have to be xrayd prior to use, but we don't place those anymore (too much confusion as to what was a midline and what was a picc, since for us, they were the same catheter. guess it is too much trouble to read the chart....)

KEVIN88GT · Jun 6, 2007

critter lover so you dont even use a portable ultrasound to do it? Totally blind? Do you aim for the basilic vein most of the time? I'm in NY and have an agency job in interventional radiology (nurses are NOT allowed to place PICCs in my facility) I work there w-f and would like to go to picc lines somewhere Mondays and Tuesday to gain some experience.... any advice on where I should go? Or where I should start? (Besides getting picc certification) are you in NY/NJ by any chance?

KEVIN88GT · Jun 6, 2007

CritterLover is correct. It is mostly the large pharmacies that service nursing homes and home health agencies that employ nurses who insert PICC lines. When I was on an IV team all of us RNs were trained and certified to insert PICCs. We never did more than 2 insertions a day. We never inserted them during the evening or night hours. The home patients usually have way worse veins than most inpatients. Our facility policy was that no PICC could be used until it's placement was verified with an x-ray. We also repaired Hickman's and triple lumens. You can find training courses through the INS (Intravenous Nurses Society).

How do I contact these pharmacies or even find out their phone numbers to find out if they need PICC nurses....I'm in Brooklyn New York but willing to do some traveling.

CritterLover, BSN, RN · Jun 6, 2007

critter lover so you dont even use a portable ultrasound to do it? totally blind? do you aim for the basilic vein most of the time? i'm in ny and have an agency job in interventional radiology (nurses are not allowed to place piccs in my facility) i work there w-f and would like to go to picc lines somewhere mondays and tuesday to gain some experience.... any advice on where i should go? or where i should start? (besides getting picc certification) are you in ny/nj by any chance?

no, for us the venipuncture is us-guided, but threading the picc is blind.

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[color=#483d8b]the bedside us equipment used for picc placement isn't quite on the same caliber as the stuff that is used in radiology. adequate for finding veins (in non-obese patients, that is). actually, it works pretty well up to depths of about 3.5 cm. after that, the resolution can make it difficult to hit what you aim for. (difficult, but not impossible)

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[color=#483d8b]it is very rare that i have a patient i can't stick. one in the past year. when i am unsuccessful with a picc, it is generally due to threading issues. some patients are centrally occluded, and you just can't get a picc into the svc, no matter what. others have torturous/stenosed vessels, and really need fluro to navigate through the chest vessels to the svc. again, doesn't happen all that often, but it does occur.

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[color=#483d8b]sometimes you need to move the patient's arm around, sometimes their head/neck, sometimes turning them from side-to-side works. sometimes nothing will help, and part of the in-patient experience i was talking about includes knowing when to give up.

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[color=#483d8b]anyway, i would suggest sending your resume to the home infusion pharmacies in your area, followed up by phone calls to try to get your foot in the door. the other thing i can suggest (how i got into this) is to talk with the sales rep that sells your piccs -- arrow, boston scientific, bard, and see if they can get you into a class. it will make you more marketable (sound more serious) if you have already taken the necessary class.