PICC Nurses input on their job.

[francoml, ASN, RN]

To all the PICC nurses out there... How do you like your job? Are you a dedicated PICC nurse or is PICC insertion just one of your many responsibilities. The reason I ask is because next month I am getting PICC certified. I am an MICU nurse and a Rapid Response nurse at a level on hospital. It is a requirement that we (rapid response) get PICC certified as well as take a class on EJ insertion. I am super excited to learn these awesome skills but I would just like some real world opinions from actual PICC nurses. So is it all its cracked up to be??? Thanks!

[Esme12, ASN, BSN, RN]

It is a marketable skill. It's not that "hard" if you are good at IV's but you will encounter difficult patients. I like PICCS but they are not useful in an emergency for they take longer....hence the EJ skill. Many facilities do not allow nurses to do EJ's. When they do they of course restrict the nurses who perform this skill. I use EJ as a last resort patients hate them.

I moved your thread to the IV nurses forum they would more likely be PICC certified.

[francoml, ASN, RN]

why do so many places restrict EJ placement by nurses? In my facility it is only allowed by ER charge nurses and rapid response nurses. Its not that hard to do and if you look at the vasculature with ultrasound its not really that close to the the carotid artery... (close being relative lol). Plus it is a peripheral line and in an emergency it is quick and easy. Obviously you need strong IV skills but beyond that its not that hard in my opinion.

[ChristineN, BSN, RN]

why do so many places restrict EJ placement by nurses? In my facility it is only allowed by ER charge nurses and rapid response nurses. Its not that hard to do and if you look at the vasculature with ultrasound its not really that close to the the carotid artery... (close being relative lol). Plus it is a peripheral line and in an emergency it is quick and easy. Obviously you need strong IV skills but beyond that its not that hard in my opinion.

At my facility ER nurses that have passes a competency can place EJ's. Also about half of our ER nurses can do ultrasound guided IV's, which is nice and faster than a PICC line.

I would be excited to be learning the new skills too, though I don't really see the typical rapid response having time to wait for PICC placement. Unless rapid response doubles over as IV team at your hospital

[francoml, ASN, RN]

Rapid response is "the" IV team at my hospital. Our order of priority goes in this order. Codes, RR calls, critical care calls (multiple traumas coming in at once in SI or ER), Chest pain calls, code stroke, M/S to ICU transfers, IV line placement (may be higher priority depending on situation ex. line for tPA, emergent blood transfusion,ect.), Sepsis screening consults, PICC placement, then transfers to procedures (non emergent).

[francoml, ASN, RN]

Also when you are placing ultrasound guild IVs do you need formal training or just OJT? Additionally, are you restricted to what veins you can use such as "no brachial veins?" We can use all veins as long as there is a medical necessity excluding IJ, subclavian, axillary, and femoral veins. Everything else is far game. Obviously brachial veins/EJ are only temporary emergent lines.

[ChristineN, BSN, RN]

Also when you are placing ultrasound guild IVs do you need formal training or just OJT? Additionally, are you restricted to what veins you can use such as "no brachial veins?" We can use all veins as long as there is a medical necessity excluding IJ, subclavian, axillary, and femoral veins. Everything else is far game. Obviously brachial veins/EJ are only temporary emergent lines.

We don't have any restrictions on where we can go, but seeing how it is peripheral, nurses would not be putting an IJ in, at least at my facility. Femoral would be done by physicians as well (we almost never do femoral lines in ER, EJ's are faster and less risky)

Brachial, and upper arm are common spots for ultrasound lines, from what I have seen.

And yeah, it is on the job training, you just have to be trained how to use the ultrasound machine before you can do it. And we usually offer a 1-2 hr inservice for staff every couple months

[Asystole RN]

why do so many places restrict EJ placement by nurses? In my facility it is only allowed by ER charge nurses and rapid response nurses. Its not that hard to do and if you look at the vasculature with ultrasound its not really that close to the the carotid artery... (close being relative lol). Plus it is a peripheral line and in an emergency it is quick and easy. Obviously you need strong IV skills but beyond that its not that hard in my opinion.

EJ extravasations or infiltrations can be life threatening.

[Asystole RN]

Also when you are placing ultrasound guild IVs do you need formal training or just OJT? Additionally, are you restricted to what veins you can use such as "no brachial veins?" We can use all veins as long as there is a medical necessity excluding IJ, subclavian, axillary, and femoral veins. Everything else is far game. Obviously brachial veins/EJ are only temporary emergent lines.

When you complete your training you should be able to cite why you prioritize some vessels and leave others alone. I highly recommend getting your VA-BC.