Published Oct 28, 2003
Are any radiology RN's placing Picc lines in their departments and if so are you utilizing fluoro or ultrasound guidance?
In the instance that you are using fluoro, is it a technologist administering the radiation?
What type of credentialling or certification is required at your facility/state?
In our hospital, our Cardiovascular Techs, assist the IV team with PICC lines. They use US, and the procedure is ususally done in the patient's room. The other hospital in town, does do the PICC's in Radiology.
My husband has picc lines placed several times a year due to having cystic fibrosis. He has them placed at children's hosp in columbus, oh. The radiologist place the piccs using fluro.
Rads use US to obtain access, then fluoro to visualize the path of the PICC line as it is advanced. Most of the PICCs go where they're supposed to, just one occasionally takes a little detour and has to be redirected with the wire. But that is why the Rads use fluoro as they advance the PICC, to save bringing the pt back after a CXR shows PICC in undesireable place.
Thanks for the replies, but I want to dig deeper...
ARNA (American Radiology Nurses Association) during their annual convention in March 2004 will be addressing the topic of establishing venous access teams. Should be a good meeting.
In the meantime, does anyone have any experience with RN's placing Picc Lines in Radiology without a Radiologist present?
When nurses use ultrasound- is an ultrasonographer required to be present?
No you don't need an US tech. Bard makes a very small US machine called the Site Rite. The latest one is the Site Rite 4, and it can print out the pics of the venipunture. Our CVT's obtain acsess, and the IV nurse then takes over in our facility.
Picc lines placed in radiology -
In our facility specially trained RNs, including myself, place Picc lines at the bedside;
we do this with Site Rite ultrasound machine if needed; when we are unable to gain access, or our catheter won't thread, we ask the radiologist to help us.
If the radiologist does the line, a Picc nurse and a radiology tech always assist him. If the problem is gaining venous access, the radiologist usually has us place a periperal IV in the lower arm or hand of the patient so he can push a little contrast through to assist him in finding a vein under fluoro.
If the problem is that the line won't thread, then he assists us in getting the line to thread under fluoro.
The nurse actually does most of the work of placing the line even when done in radiology. The rad tech pushes the contrast and runs the fluoro, but otherwise does nothing in the placing of the Picc lines. Not all of the radiologists at our facility are interventionalists, so we really only have one who will actually mess with Picc lines at all - but he is also the radiologist that I work with doing angios, so we work well together. (I am a radiology nurse who just happened to be a Picc nurse also!)
We have never placed a line in radiology without the radiologist present. This is just the way it has been since we started placing Picc lines at our facility.
However, let me point out that we have pretty good success placing Picc lines at the bedside especially since we got out SiteRite. We rarely have to ask our radiologist to place a line under fluoro.
I think you will find that who and where Picc lines are placed varies greatly from facility to facility.. There is a website called smartgroups.com (I think) that has a vascular access group on it. I view this site regularly and I find that some facilities place all their Picc lines in radiology, some use radiology only when necessary, etc... Most of the people on this site are nurses and I really haven't heard them mention anything about radiology techs or cardiovascular techs placing picc lines. At our facility, the rad techs and cv techs do not place lines.
Hope this helps some and wasn't too confusing!!!
Our IV team will try to place PICC lines at the bedside, if they aren't able to do it we go to radiology to have it placed under fluro by a nurse and tech. They do a fantastic job. I believe they have the final placement reviewed with radiologist.
Im a PICC nurse in Radiology. I use US (Sonosite) to locate the vein, Bard PICC kits and have been hospital credentialed to use flouroscopy for guidance. The Radiologist reads my spot film for tip placement. 15 minute procedure for the patient, 100% accurate placement, no contrast needed. Flouro time 5-20 seconds.
A well placed PICC is a work of art.
SonoSite, too, makes a miniature U/S system called the iLook. It can print and send digital images to a network, and doesn't use mechanical transducers as does the Bard system.
Hi - im a radiology specialist nurse in Leicester, UK.
I am trained to place picc/Hickman lines under U/S and Fluro tend to place more Hickman lines into the subclavian than PICCS
I also report and verify tip placement myself.
Hi by the way - new to the site, hope to become involved actively in various threads.
Very interesting thread as I am currently in training for PICC placement...thanks to all for the excellant information!! :)
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