Please Help...Advice.

[NrsLucky]

Okay so I want to start off stating that I am an LVN. I do not touch PICC lines. I have a question for RN's who know their scope of practice regarding them. So I have been picking up shifts in a Sub Acute SNF lately in order to work with a good friend of mine who wanted me there to help him. I generally have always avoided SNF's because of the high volume patient load and the small number of staff I had to assist me in providing exemplary patient care.

My friend is an RN who has his BSN but went to school in the Philippines. This is his first job in this type of setting. He previously worked for about 5 months in a Doctors office and also in Home Health. This particular SNF that we work at promised him adequate orientation and training however only gave him 2 days of it before releasing him on the floor alone. I anticipated this would happen which is why I requested to have my status changed to per diem awhile ago. In order to help compensate for this facilities lack of orientation and training I requested to be put on shift with him and was granted this since I have a great report with the managers and the staff. I was "secretly" "orienting" him as best I could and for the most part did a great job since in this type of setting I can function in a higher capacity compared to when I am working on Med/Surg.

Things were going great until one evening when I was not there he had a situation in which a patient was bleeding steadily from a PICC line insertion and who was under his care. He phoned the MD who informed him to remove the PICC line and apply a pressure dressing. If this did not stop the bleeding than he informed him to transfer the patient out. My friend dc'd the PICC line as directed and attempted to apply pressure. The bleeding continued and the patient was transferred out. The Charge returned from I am assuming break and my friend gave a report of what occurred. (The Charge does not like my friend or any foreign nurses for that matter, I know this because she told me this when I worked there full time.) She of course immediately pointed out that my friend was not PICC certified and should not have touched the line. This is where my heart dropped because I had no idea he wasn't certified. I feel so horrible because I didn't tell him that he needed certification for this. He was oblivious to this fact as well. His take on this is that although he feels very bad he had no idea that he could not touch these lines because in the Philippines you do not need a certification and he used to start them and dc them all the time. He also is upset because he feels he was never oriented appropriately or given all the rules as he should have been. He wasn't even given an employee handbook or told where he could find the policies of this location. I'm not going to get into what actions were taken against him, but he was reprimanded. He is asking me for help but I do not know what to say. So I want to know if he was horribly wrong in this situation and if so were severe disciplanary actions indeed necessary? The Charge Nurse has been relentless in taking action against him.

ALSO: This was just a basic summary. The MAR was checked etc. before he dc'd the line and there were other steps taken as well...

Your opinions would be greatly appeciated...

Respectfully,

NrsLucky

[LoveSbux]

I'm a new RN (still on orientation) working in acute care and while I had to take a course for IV certification nobody ever mentioned PICC certification to me. I do need to be checked off on PICC and central line skills (blood draws, dressing changes, removing a PICC) during my orientation but my preceptors have been letting me perform these skills after discussing and reviewing the procedure.

This may be a facility-based restriction (ie. the facility never certified that he was competent with PICCs)....I hope it all works out for your friend.

[TheCommuter, BSN, RN]

Most, if not all, state BONs permit RNs to care for PICC lines without any additional certification. After all, IV therapy is included in our licensure.

If your friend needs additional 'PICC certification,' this must be an individual facility policy. However, I can almost certainly assure you that it is not part of any state's particular regulations.

[classicdame, MSN, EdD]

Read the hospital policy. In my facility any RN can remove the line, but only a certified RN can insert the line. Always, when over your head, call the house supervisor if any, or a seasoned RN. Read the nurse practice act too. They may not require PICC certification, but will probably have a catch phrase addressing what to do if there is no competency documented for a particular task or what a prudent nurse would do. The facility is somewhat culpable. If they have patients with PICC lines they need to create an environment where these patients can be cared for 24/7 per their own policy. So if the policy states you have to be certified to remove or insert one, then the facility needs someone there 24/7 who is certified.

[Been there,done that, ASN, RN]

Your friend needs to get the h*ll out of there. It is only going to get worse.

Charge nurse will push it until he gets in major trouble. In the mean time, he must find and read the policies on his own time, and call for back up for anything he even suspects could be trouble.

[mazy]

Our RNs in SNF/LTC remove PICC lines all the time. They don't have any special certification. You do have to be certified to place them, but I've never heard of being certified to remove them.

[beckster_01, BSN, RN]

At my facility (inpatient), RN's must be PICC certified to insert/remove a PICC line (usually we just have our NP do it). From the wide variety of responses it looks like you will need to look at your P&P manual. It could differ between states as well.