Picc line callbacks!! HELP!!

Specialties Infusion

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Help!! I work at a 250 bed hospital on a PICC line/IV team in which we are on call for after hours picc line insertions. Our normal hours are 8-4 with call backs the remaining hours. We get called at all times throughout the night and even on the weekends several times a day. We have a protocol in place in which nurses should assess their patients and call only if neccessary and attempts have been made by anesthesia and supervisors ect. I need to know what other hospital policies are involving call back and after hours insertions. I dont think that picc lines should be an emergent procedure like they are being treated here. Please any help would be appreciated.

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Specializes in Infusion Nursing, Home Health Infusion.

Let me ask you a quick question..what types of pts are you getting the late requests for.....ICUs...ED..septic pts....can not get anything else in pts ...pt needs urgent CT scan...amio....you get the idea. it really sounds like you need to expand your hrs and you need more FTEs...you need to keep a record of all the call backs. I have found if you have it set up that you can be called. after hrs..NO the calls will not stop and you will all be run ragged. If the MDs and nurses are on their own after you leave..they will manage..the MD will have to put in a CVC if needed...if they know all they have to do is call the on call PICC nurse..they will call. If it is driving you guys nuts you can make parameters and stick to them...yes there are many drugs that it is best to give through a central line but in an urgent situation we will give it through a PIV and get in a CVC as soon as feasable. Are you doing a lot of ICU PICCS where they want to monitor CVP and follow the sepsis IHI protocol? Also do not forget that modern PICCS are very versatile...you can power inject through certain brands.....monitor CVP on non valved open -ended types...you have multi-lumens...they have low infection risk and are considered intermediate to long term lines..so we used to say there is no such thing as a stat PICC but that has changed in a lot of facilities..let me know more

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The types of patients varies some are critical but the majority tend to be for access, some maybe for TPN or IV access for dc patient home on long term abx. For the most part we really don't give the nurses and MDs a hard time about the emergent ones but more so the patients that have been there a week or so already and on 4pm sat afternoon it is Stat cause they lost their access!! We do have a protocol but its not being followed and we do keep up with callbacks also. MDs hardly ever place cvls anymore cause they can just say get a picc line and they can call us in....just wondering how this is handled in other facilites and if its the same everywhere cause they are running us ragged for sure!!

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Specializes in Infusion Nursing, Home Health Infusion.

Ok so what you need is a way to identify earlier the patients that will benefit from a PICC line. This will also help with preserving the pt's veins. It is not wise to trash all the good veins and then order the PICC. Bard has a program that you may use or you can make up yourself...I think its called Early Advantage or something like that that helps you identify those pts...you will also have to do some training with all the nurses. So for example, a pt is diagnosed with endodocarditis...osteomyelitis.....you know they will need long term IV abx.....you should be immediately called. Training the staff does help as well as reviewing diagnoses. You can also set up a link with pharmacy so that you are notified when the patient is receiving certain medications/treatments so you can intervene early. Of course, TPN can not be given through a PIV but a lot of things can for at least a short period of time. So if you are called to place a PICC after hours for Vancomycin..that is not urgent..they really need to try and place the PIV and then you can place the PICC during regular hours. If they want fast PICC insertion they will have to pay for it...in a way they are by keeping you "on call"...BUT its still cheaper for them than to add FTE's. Sometimes you have to let a problem happen without rescuing before the powers that be cut loose with the bucks to get the job done. The trend is clearly to avoid fem CVCs....use Subclavain and Jugulars for very short periods of times..and them get them out...b/c as of Oct 2008 Medicare will not pay for any catheter related blood stream infections ..so everyone is looking for the type of line that meets the pts needs with the lowest possible risk for complications including infection for that particular pt ( a tall order at times) I will see if I can get the name of that program but I agree you can improve the process at the nursing level. You can also work with the MDs and ask them to order early.

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