sbivrn

CRNI stands for Certified Registered Nurse Infusion. To become a CRNI you must currently work in one of the nine core areas of infusion nursing, and pass the certification exam. Not all CRNI's place PICC lines. This is a national certification by the Infusion Nurses Certification Corporation and is accredited by the American Board of Nursing Specialties. We operate under the INS standards of care for infusion therapy. You can find out all you need to know by visiting http://www.ins1.org. In most institutions, the rate of pay for nurses with certifications is higher, and it also helps in marketing yourself. Hope this helps!

Interesting. I place the patient completely supine, except in cases where the patient cannot tolerate it. When making the turn at the shoulder I have the patient turn their head toward me and angle the chin down to the shoulder. This almost always works like a charm. I have had to sit the patient comletely up to get a line to drop, but it is rare. If the patient is not able to follow commands I have a nurse come in to help position the head.

Sure, but it's taken us to some neat places :)

Perhaps I have been unclear. I do not do over the wire exchange for clotted PICCs. The result would be no different than that to which I am objecting. Our two options are to use Activase to declot the picc or to pull it. Never to stick a wire into it.

Over the wire exchange of a PICC line is a totally different issue. The validity and safety of the procedure is well documented. We accomplish this quite safely at the bedside. This is also done in Radiology. You cannot compare declogging a g-tube with a wire, to declotting a central line in the same manner. It is foolhardy and puts the patient at risk.

The first couple of years post nursing school can be overwhelming. They just cannot teach you everything you need to know. so you will get quite a lot of on the job training. As bad as it seems on new grads, it's much better these days. I started out 20 years ago during a time when nurses ate their young! There was a terrible shortage of nurses and basically if you had a pulse and a license you carried a full load and then some. There was no such thing a new grad orientation or preceptors. No one had the time. I am proud of where we have come in the last several years. It is still hard, but it is better. If you can mangae to land in critical care it would be a great asset for your career in IV therapy. The patient to nurse ratios are much more reasonable and they are accepting more and more new grads into the ICUs without making them wait on floor nursing experience. And truth be told they love male nurses for the ICU. Don't be intimidated by the atmosphere. You are never alone. You will become very familiar with multiple infusion medications and learn how to properly care for central lines. You'll learn what you can run safely through which kind of line. Just keep in mind most things run just fine through a 22 gauge needle. Even blood (you just need to run it a bit slower). With IVs, bigger is not better in every case. INS standards say use the smallest needle in the largest vein possible for the prescribed treatment. ER and ICU nurses in general still love those large bore IVs. Sometimes they are appropriate, but not in every case. Give yourself a year or two in the ICU and you'll be ready for the IV team and PICC line placement. Good Luck!

Just saw your question. You can certainly make a career out of vascular access nursing. It is much more than running here and there starting IVs. I am not aware of any specialty IV teams that will hire a new grad, however. Most will want a few years of bedside nursing under your belt first. You cannot skip this step. You need to hone your IV starting skills and learn more about vascular access in general before you can be effective in this area. But should you decide to go that route there is a certification- CRNI- that will be helpful for you to get. I love this area of nursing and cannot see myself doing anything else right now. But be forwarned it is a fast paced field and patients as well as the nursing staff will come to depend on you as a resource.

Lots of luck to you. Love to hear about anyone making new strides in vascualr access for their institutions. You're doing a good thing!

I don't believe you'll find any articles on blood draws from midlines. I am not aware of any. We do not do blood draws. Maybe I was unclear. We check for a blood return upon insertion. Then flush really well with NS.

Yes we do use blood return as an indicator of satisfactory placement. We do not xray midlines. We typically use (on the adult patient) 4 french single lumen catheters for midlines, cut to have the tip locate in the axillae. We will flush afterwards with 20ml of NS and use the CLC 2000 positive pressure device on the end to help maintain patency.

I agree with Diana. Where did the clot go if not into the patient's vascular system? This is not an INS standard of practice. This should not be let go. Many people cover a lack of knowledge with bravado! :)

I am very proud of the IV team of which I am a part. We are a part of Gaston Memorial Hospital in Gastonia, NC. There are 9 of us and 7 of us are CRNI's. We cover the hospital 24/7. We place 150-180 PICC per month. We place several hundred difficult IVs each month as well. We are responsible for making rounds on every kind of central line in the hospital and doing the neccessary site care for each. We are presently involved in a study that tracks all central lines placed in an ICU setting from the date of placement until discharge or removal. We work very hard and we are proud of what we offer our patients and our staff. The nurse who started our team a few years ago has now left and is presently teaching other hospitals how to implement IV teams in their institutions. If you contact Bard Access Systems they can get you set up with a person to help you get started. ( This is who our former staff person works for :)

That's interesting. Do you place midlines in the same manner as PICC lines? We use the modified seldinger technique for both and don't have anymore problems with bleeding from one to the other. It usually depends on the bleeding times and whether or not the patient has been on a thinner. If we have bleeding after insertion for either we do a gauze dressing for 24 hours.

Those are hard ones, no doubt. You are dealing with poor skin tugor, probable dehydration, and poor venous status. Just make sure you are not using a catheter that is too big. A 22 gauge catheter is plenty big for most infusions. Forget what they told you in nursing school about that. INS standards are to use largest vein with smallest catheter possible for prescribed treatment. Sometimes a peripheral IV is just not possible. In those cases ask the MD for an appropriate central line. (picc, IJ, Sub clavian) This will also cut out lab sticks for these hard to stick little old folks.

Wow- I've never heard of trying that. Do you mind telling which brand of picc needle is giving you the trouble threading the wire?