Practice question

[kokomol]

Do IV nurses usually practice in teams? What is the normal nurse patient ratio for PICC insertions, midline insertions, or CV dressing changes at your facility?

[iluvivt, BSN, RN]

Different hospitals do different things, but with the PICC market is growing by leaps and bounds many hospitals have had to implment teams or beef up the ones they had especially after trying to get rid of them in the 90s. We have 3 IV specialist on per day with staggered shifts starting at 0630 to 2000. We send 2 nurses to insert PICCs all day and the other carries the rest of the hospital. The pager nurse answers all pages, performs all PICC dressing due and prn ones, performs all IV starts that the nurses cannot get, performs any complex troubleshooting on any IV issue, performs skin testing,administers TpA, and locates PICC course and PICC tips to release PICC for use. Sometimes we are so busy we all have to put PICCs in. We are always busy. We place 150-200 PICCs per mo in addition to our other duties. Many days we can not get in all the PICCs for which we receive orders and we try to catch up the next day. I love vascular access, but it is not a piece of cake by any means you have to have a lot of patience and a ton more skill than patience

[kokomol]

Thanks for your input. When you say they work in teams, do you mean that two of them work together on each patient to insert PICCs?

[iluvivt, BSN, RN]

yes we mostly send 2 nurses now. One reviews the chart, talks with the RN, etc and helps to set up. The other RN starts scanning the vein(s) with the Ultrasound and making a vein selection. There are times I have inserted by myself, but I an tell you if anything goes wrong there you are by self.....sterile.....so if you drop your guidewire on the floor you have to de garb and regarb and i cannot tell you how often the other nurse just helps the patient get through the procedure

[legaleaglern]

I am a PICC nurse and we have a 300 bed hospital. In 2005 when we started our US guided PICC team we had 3 RN's... 2 to place PICC's and one to cover the house. Now have 2 PICC cert RN,s who place PICC lines as a team and 3 IV RN's to cover the house. We average 100-150 PICC's and 1,000 IV starts per month. We were able to get more staff when I kept asking how much money we save the hospital at every meeting I attended. ( My co-workers complained to me when I kept bringing it up. They were afraid they would think we need less staff). I put a power point presentation together with graphs as to how much money we save the hospital directly and indirectly and how many Piccs we do and how many IR does not do as well as the picc procedure.

I also asked about priorities....do you want us to place the PICC or go to peds and start the IV on an infant? There were times when we have several PICCs to do we would call the supervisor and tell them we are turing off the beepers because we can't answer the pager and maintain sterile technique at the same time.

It took about a year but our staff was increased and our status is advanced specialty RN which means we got a big salary increase. The squeaky wheel gets noticed so just keep speaking up and keep reminding how much money you are saving them and how highly skilled you are.