PICC placement and insertion complications

[PICC.CA]

I am working with medicare to see if we can be reimbursed for placing PICC lines. Their concern is we are not in a hospital to place the PICC's where we could call on MD's if complications arise. PICC's have been placed for years in the home care setting, so why can't we do it as independent contractors? Is there any regulation allowing or disallowing outside placement? Any research or guidance would be appreciated! Also, potential complication with insertion...direction to percent of insertion complications would also be helpful>

[Mandy LVN]

I personally would be very uncomfortable having a PICC placed in the patient's home. I have seen way to many complications in the hospital with placement to feel that it is safe. IMHO it is safer to have it done in the hospital where there is plenty of back up and a chest x-ray can be done immediately to confirm placement. And it's also at least a little easier to keep a sterile field in the hospital than in the patient's home.

[casi, ASN, RN]

We get PICC lines placed in LTC all the time. I don't see why you couldn't get one placed in the home setting.

[iluvivt, BSN, RN]

I have placed PICCs in all kinds of setting...in the home..in an OP infusion suites both hospital based and those that are set up in by non hospital based infusion companies and in the home. It is a bit different now b/c of all the advanced technologies being used now. There is NO doubt that when using a US to place a PICC above the ACF..the complications are reduced. So you will have to bring an US to the home IF you want to provide that that level of care. There are different challenges in the home that make it more difficult...a big thing for me is that I could not raise the bed or gurney to my level...setting up max barrier precautions could be challenging..using a TLS could be challenging if you are alone depending upon the type you are using. Then if you are having an access issues.....you can not really take off your gown and call for another PICC nurse and that can be wasteful and expensive as you would have to discard your tray . So lets say you get the PICC in then you either have to have a portable CXR in the home OR the patient has to go get a CXR...at least that is still the current standard even with advanced tip locating systems. Have you placed a lot of PICCs or have you seen what is really involved?

I will only place them in a hospital setting or in an infusion company IV suite.. I find placing them in the home a BIG Pain and I have been placing them since 1989 so it is not b/c of any reticence.

[Esme12, ASN, BSN, RN]

i am working with medicare to see if we can be reimbursed for placing picc lines. their concern is we are not in a hospital to place the picc's where we could call on md's if complications arise. picc's have been placed for years in the home care setting, so why can't we do it as independent contractors? is there any regulation allowing or disallowing outside placement? any research or guidance would be appreciated! also, potential complication with insertion...direction to percent of insertion complications would also be helpful>

what kind of an agency are you or are you setting up a new business to go around as consultants inserting piccs.........your biggest hurtle would be a medical director taking responsibility and yoiur individual state practice acts supporting the home insertion by rn's or not. the rest would be standards of care and policy.

a resource:

http://www.piccresource.com/faq.php

fortunately, state guidelines and organizations such as the infusion nurses society (ins) exist. the ins is a non-profit organization established in 1973 to ensure high quality in infusion therapy for patients and to establish standards and guidelines to be followed by nurses involved in the specialty practice of infusion therapy care and procedures. the ins has published standards of practice position papers that require clinicians to possess and demonstrate specific and comprehensive knowledge related to picc insertion and care. another important organization is the association of vascular access (ava), ava is a multidisciplinary organization composed of clinicians, educators, regulators and manufacturers from the medical field of vascular access. part of ava's published mission is to improve patient safety, comfort and outcomes; and optimize professionals' knowledge and skills in vascular access. the best programs will have their education and clinical assessment criteria founded on the basis of standards, guidelines, and recommendations set by government and leading industry organizations such as the ins and ava and organizations like the center for disease control (cdc), the joint commission (jchao), and the institute for healthcare improvement (ihi).