PICC NURSE

"nursy", RN · Oct 30, 2019

I was the PICC Queen for about 20 years. Started doing it in the home health setting, then traveled to various nursing homes, then ran an Infusion Team at a hospital. I absolutely loved it. I got in early in the days where you took a course for a day, someone watched you put one in, and you were on your own. Back then there was no ultrasound, and you had a sterile field the size of a handkerchief and a mask. I've probably inserted more than 10,000 PICCs. Things have changed, though. Everyone wants to teach you the course, but no one wants to precept you while you're trying to learn. It takes a minimum of 50 PICCs before you can safely say that you're good at it. That's tough to do in the hospital where now an insertion can take an hour with all the gowning and draping, and a witness to make sure you don't break sterile technique, etc. I used to have a lot of nurses watch me do it, then say, hey I want to do that. When you're good at it, it looks very easy. Then they would take the course, find someone or other to watch them the first time, fail miserably, realize it's not as easy as it looks, and never really get around to becoming proficient. Before even taking the course, I would say make sure you have a situation lined up where you have someone who will faithfully precept you. Then there's the matter of finding enough patients who won't object to someone learning on them.

When I was in Florida there were several companies that hired PICC nurses as independent contractors to service nursing homes, and some hospitals. That's what I did. However, as an independent contractor, there were no benefits, and you only made money if you put in a line. I made a lot of money, but I made myself available pretty much 24/7, and I covered 3 counties. I also lived in a busy metro area so there were always PICCs to place.

So, I hope I've given you some insight. Good luck!

MforMs · Oct 30, 2019

That information is really helpful. Would you be able to explain to me how does travel and equipment work? Did you have your own ultrasound, or pick it up from a central location? Did you get paid per picc? Do you know what the going rate is nowadays? Trying to understand the logistics of working independently.

Thanks!

"nursy", RN · Oct 30, 2019

I wish I could be more help, but I've been out of the PICC business for several years. I do know that, if you live in an area where companies hire you as independent contractors, they will provide the ultrasound machine. Back then, you got paid per PICC, everything else was on you. Every area, and state, I think has completely different opportunities. The types of companies I worked for in Florida don't exist in my current state. Back in Florida, my rates were variable between companies from 75$ to $200. I'm sure they are higher now.

In the hospital, I had a great position, except I was on call. On call pay was very good, except that on call gets tough after awhile. You would have to look at opportunities in your specific area and talk to local PICC nurses to get a more accurate picture.

erwindt, MSN, RN · May 14, 2020

"nursy", RN, I love this comment... "I used to have a lot of nurses watch me do it, then say, hey I want to do that. When you're good at it, it looks very easy. Then they would take the course, find someone or other to watch them the first time, fail miserably, realize it's not as easy as it looks, and never really get around to becoming proficient."

That is very true and I agree with you 100% on it. I've always been a critical care nurse, wanted to pursue CRNA, just like the rest, but I was recruited to be one of two PICC nurses at my facility. I know, in nursing, either we want more $$$, more titles after our name, etc... I learn to just let your career guide you, not the other way around. I love being a PICC nurse. I get a lot of respect from doctors and my colleagues. I work very independently. When you have mastered a skill, others think it is a piece of cake. I love sharing my skills and even my techniques, but if someone is overly confident of themselves, they will never succeed or get it 100%. Like anything else in life, nursing is a learning process for life.

I encourage all nurses to always challenge themselves, acquire new skills, and keep yourself up-to-date to evidence-based practices, especially these unpredictable times we're in. Don't chase the $$$, let it chase you.

LibraNurse27, BSN, RN · May 15, 2020

I'm curious, how do you do a PICC with no ultrasound? I am trained to do ultrasound IVs but not PICCs and I've never seen one done without ultrasound. How do you see where you're going? Just curious! If you don't mind sharing ?

erwindt, MSN, RN · May 16, 2020

LibraNurse27, yes I have heard of other nurses placing PICCs without an ultrasound, but am told, those were the days. I know, just the think of it makes me cringe. It's like being blindfolded while driving. I guess because I've never done it before, but I must say that those nurse are pretty darn good at it. I've met nurses that places PICCs via fluoroscopy, but when they place PICCs at the bedside, their measurements are off or not perfect, meaning their catheters are either too long or too short.

iluvivt, BSN, RN · May 16, 2020

Yes, you can place a PICC without the use of Ultrasound because you essentially use the Ultrasound to access the vein above the ACF. Once in awhile now I do not need the Ultrasound because I can easily access the Basilic ven well above the ACF.This is usually on a thin male with good muscle tone and where the desired vein(s) can be easily palpated and/or seen.I have been placing PICC since the lates 80's and we used to access mainly at or near the ACF, along the Cephalic vein (which is easy to access all the way up the arm on a lot of individuals) and the occasional Basilic vein above the ACF. I only use the Cephalic now if there is no other option. It's so true it looks easy but it's not.I am training a nurse now and she said you make it look easy and it's so not! To access a vein now by palpation, visualization or with use of US seems so natural to me.It's like writing with a pen,you don't even need to think about it.I have spent almost my entire career in vascular access and home infusion and have always had a passion for it and also love to study all aspects of it.

erwindt, MSN, RN · May 16, 2020

iluvivt, totally agree with you. When we've done PICCs a million times, it looks easy on the eyes of those that haven't place one. I welcome others to join our specialty, but I don't like it when whey say, I like your job, it "LOOKS" easy. I often get called for difficult sticks and I help the nurses. When I arrive in the unit, they hand me the vein finder. First, I thought it was a Glucometer, but it's a vein finder. I kindly informed them, I don't like vein finders. They make me see birds flying afterwards, LOL...

LibraNurse27, BSN, RN · May 17, 2020

WOW!, I never thought PICCs looked easy! Maybe that means I have no hope of being good at them, LOL! I like doing ultrasound IVs, but the guide wire and putting something near someone's heart terrifies me!! I don't want to "tickle" the atria and cause an arrhythmia or something. It's too much responsibility for me. So I SO appreciate you PICC nurses! I can call you when I see that PICC order and I don't have to have nightmares about inserting a PICC into someone's ventricle by mistake LOL

erwindt, MSN, RN · May 18, 2020

LibraNurse27, don’t be afraid. Come join the club. I felt intimidated and scared when I first started 6 years ago, but is not bad. Vascular nursing is by far the best secret job. You are independent, but don’t have an NP responsibility. Most of all, very well respected because they will need you when surgical and medical residents are unable to place a other route of central venous access. You are already accessing veins with an ultrasound. The ultrasound is the most intimidating part and you have already mastered it. I think you will be great.

MforMs · May 18, 2020

erwindt, MSN, RN

Thanks for that insight. Can you provide some specific guidance how I can get involved in PICC placement? Specifically, I would love to transition to out of hospital PICC placement. I have pretty sound ultrasound skills currently, and 5+ years of critical care experience