PICC team

It is more difficult to place PICCs in the hospitalized patient because patients are becoming more and more venous depleted. Do you use Ultrasound and Microintroducer technology to assist you in placing these lines? Is your hospital proactive in their approach to PICC/Midline placements or reactive?

No we don't use ultrasound or microintroducer tech. We still work by what we feel only. Efforts to educate administrative people concerning what we need are going very slow. Their pat answer is always that we need to train more nurses to help.

Got my hands on a proposal today for an independent company to contract for doing all our PICC's. It apparently started at the top and the buck's been passed down through the ranks; iI think looking for someone who understands it?

Hi rnwayne...

We have a PICC team, consisting of RNs whose sole purpose is the placing and care of PICC lines throughout the hospital. They don't take a patient load, rather they are "on call" throughout the day and stationed in radiology. So if your patient has a PICC that can't be flushed...they can come and TPA it or assess for patency.

vamedic4

got a break from the heat!!

Hello, rnwayne!

I, too, was at one time one of two RNs who placed PICCs (by feel) in a 325-bed hospital. I also worked in a busy cardiac cath lab. If it was a slow day in the lab, it was no problem, but more often than not, we were very busy and I couldn't get to the PICC until the late afternoon/evening. If we were not available and the patient needed the PICC sooner than late afternoon, they were sent to Radiology and a radiologist would put it in (at greater expense, of course). So I feel your pain and frustration.

Keep the faith!

Sherri

a couple of issues here....how many piccs per month is your facility placing (both at bedside and primary sticks by radiology -- meaning they went to radiology first; not pts that had to be sent to radiology because the bedside stick was unsuccessful). is it enough to warrent a ft or pt rn dedicated to placing piccs? or a nurse that placed and maintained piccs? (that is, dressing changes, trouble shooting, etc)

also, how many piccs is radiology placing because you are unsuccessful at the bedside without "modern" equipment (ultrasound, mst technique). this number may be difficult to determine, as it will require jungement of the radiologist on what your chances of success would be at bedside. are your radiologists supportive and likely to assist you in getting over your "learning curve" with new equipment?

the question a pp had about your facility being proactive vs reactive is a good one. if your facility is being proactive, then a job of the picc team could be to screen new admits/transfers to the facility to see if they would benefit from a picc.

i work for a company that places piccs in a fairly small hospital that is within a larger hospital system. the other hospitals within the system are large enough to have their own picc teams. this smaller hosptial, however, isn't. they have tried in the past to take the same approach as your facility: train bedside rns, and make them take a full patient load plus do the piccs that are ordered. but it hasn't worked. so, they contract with us to place their piccs. it seems to work out well.

i would think, though, that with 140 beds, that should be enough business to keep a ft picc nurse going.