PICC "team" questions

CritterLover, BSN, RN · Jul 31, 2006

1. i place them alone, unless i need help positioning/restraining the patient. then i get a bedside nurse/aide to help.

2. our hours are 0830-1700 m-f and on call 0800-1700 sat/sun

3. well, not officially. this is scope-of practice dependent so it will vary from state to state. in my state, we cannot do a "wet" read for placement, and must wait for the official word from the radiologist. i do, however, look at all of my xrays.

4. yes, but they hate placing them. they work m-f 7p-3p, and will not come in on the weekend.

philly22 · Aug 1, 2006

1. We insert PICCs alone unless we are not busy with consults. We usually have 2-3 PICC nurses on per day and place between 200-250 PICCs per month.

2. Our hours are 0800-1800 M-F and 0800-1600 on the weekends and some holidays. Right now we only have on call for the major holidays.

3. Just like critterlover, we are not able to "wet read" our x-rays but we do look at each of our films. We too have to wait for the official read from the radiologists.

4. We do have radiology "back up" if we need them. They do not like to insert PICC lines if they don't have too. We have greatly reduced their amount of insertions since we have started using the ultrasound machines. I love them!

Mic H. · Aug 29, 2006

First, let me say that I wear two hats. 1) As a PICC team member at a 300 bed hospital and 2) CEO of a PICC placement business.

1. I never place a PICC alone. In the hospital I require a tech, CNA, nurse, or nursing student to be in the room during the insertion to ID the patient with me for the "Time Out" and assist the patient and me with anything during the procedure. In the various facilities my company places lines for, it is written in the contract that a non-physician medical personnel from that facility be willing and able to assist. I fine that at the moment things aren't going as planned it is not the time to have to call for help, wait for them to wash their hands and don mask, hat and gloves to assist.

2. Hospital hours for the ONE PICC nurse are 0700-1900 M-F and 0700 - 1500 Weekends and Holidays. Company hours are 0800 -1800 M-F and 1000-1600 Weekends and Holidays.

3. Indiana is one of the states that allow nurses to interpret PICC tip locations and release for use. I believe at last count there were 14 states total that allow this practice. The trick in this state is to get the radiologists and the hospital to back the idea. We all have access to the digital image and look at every x-ray, but no facility I work with right now has allowed the line to be used until a radiologist verifies the tip location.

4. It is very rare that we need to send a PICC to Interventional Radiology. Just like all the other replies, they hate to place them and their schedule is usually packed to the point that the pt. has to wait 24-48 hours for placement. MST/US has really changed things for us bedside PICC nurses.

nwnurse · Sep 11, 2006

I am very interested in learning to place PICC lines. The hospital I currently work in has enough PICC trained nurses according to management. However, there are many PICC nurses in the team that would be willing to give up their role as PICC inserters if given the chance. I do very well inserting peripheral IV's on adults and pediatrics. I have been described as one of the best in the department especially with kids. However, I work the night shift and no PICCS are done at night. Additionally, the department has a hard time filling the night IV position. I really want to advance my knowledge as an IV nurse and learning PICC's would be the next step for me. Can anyone suggest an approach/rationales that would be helpful in encouraging the department managers to consider training me? Thank you so much.

CritterLover, BSN, RN · Sep 12, 2006

what kind of education/training does your hospital require for their picc nurses?

most institutions require a class, followed by so many hours of bedside training.

if that is the case at your hospital, then i would suggest getting them to send you through a class so that you can be "a good picc resource at night." you will have a better understanding of them, and be able to help trouble-shoot. i get called to look at piccs all the time because of one problem or another -- real or imagined. things like, "i went to change the dressing and the line is out x far. " well, if you look at the documentation, that is how far it was out when it was placed. no problem. thing is, they will often stop using the picc until i can come and assess it. then the patient ends up missing several hours of therapy needlessly. i try to do inservices, but with the high turnover of floor/unit nurses, it is tough to keep everyone educated and up-to-date. i often wish there was someone else around who could help people trouble-shoot, especially at night. then, once you have been though the class, it will be easier to convince them to get you checked off. maybe you could work prn or as a fill-in picc nurse for a while, until a position opened up.

but, just a couple of cautions:

first, are you sure there are nurses that would be willing to give up the picc position? i ask that not because being a picc nurse is so wonderful (i love my job, but honestly, it is one of the higher-stress jobs i have had in nursing -- there are days i truely contemplate going back to the er full time), but because i would think that they would have resigned already. there must be some reason why they continue to be picc nurses instead of something else. there is too much else available in nursing, and no one can force them to stay.

the other is that being a good iv nurse doesn't necessarily translate into being a good picc nurse, especially if your facility uses ultrasound. don't get me wrong -- being a good stick can only be an asset. but there is so much more to placing a picc than getting in the vein. this weekend i put a picc in a guy that i had no problem getting into the vein. but, to thread the picc, i had to have two people help me so i could get him rolled onto the opposite side while the arm i was working on was pulled out at a certain angle. all while maintaining a sterile field.

i'm not trying to be discouraging, really, i'm not :wink2: . but the first several months of my picc career were more frustrating than being a new grad. good luck, and let me know if i can answer any questions.

sbivrn · Sep 19, 2006

1. I work nights so I place piccs alone

2. we have 24 hour coverage

3. we are in process of writing policy to read our own cxr confirmations

4. We do have IRs availalbe on day shift, but only to place those we could not.

~*RN*~ · Mar 13, 2009

I would love to hear more about your PICC business as I am extensively looking into to starting my own in Mi. Any tips would be much appreciated. Thanks!

jlamb15 · Oct 2, 2009

I see that this thread is a little old, but would like to talk with PICC RN's in N. Calif.....

jesswill · Oct 9, 2009

1. Do one or two nurse go to place the PICC line? Always 2

2. What are your hours of service for PICC onsite vs on-call? We place PICCs from 07:00 to 18:00 during the week and 08:00-15:00 on weekends

3. Do nurses placing the PICC do the evaluation of the xray? we evaluate, yes. We cannot release the PICCs, however, without the radiologist reading

4. Do you have a intervential radiologist in house that also can place? Yes, but they don't do it often.

cheryl co · Jan 6, 2010

if i may be so bold, hi im presently working at PMH in western australia and we are presently updating our picc line care,ie;dressing management, flushing and blood sampling from. Thus am interested in what the rest of the world is doing in regards to these processes/protocols. cheers chez