JOPICCRN5

Our most recent trainees are taught during the PICC class to use ultrasound with no additional training given. But when they do their practice during the training they dont use the ultrasound. Does that help? I am located in Iowa. Our PICC team uses ultrasound.

Thank you so much for your information. We are beating our heads against the wall with docs pulling our lines and not getting proper cultures. We even had one say he didnt care what the cultures came back as he still considered it a PICC line infection. I do know all our tips we have been able to get cultures on have been negative. Yes we use ultrasound to place our PICCS. I wouldnt place one without it.. and when I first started we used to place without ultrasound. Nothing like poke and hope you didnt hit the artery. I am going to check out the websites you have given me and will also e-mail you for the cheat sheet. The nurses on the floor try to give good care but we are in a situation where we are expected to do more with less and it is frustrating all around. Thanks again. I have read alot of your posts and value the information you give. I have directed some of my coworkers to this website also. Hope to see them on here. As far as the maximal barrier thing I have not seen them come home from Iowa City, Des Moines, or even Mayo with one of those so would be curious to know who out there is using them and is it just for the first week or more?

iluvivt.. i need to give you more info but am just really tired right now and not thinking clearly. I will try to gather more info and get back to this post. I work the weekend so it may be Monday. Thanks for your info.

Sorry it has taken me so long to get back. Been busy working. I remember from my PICC class(many years ago) that is can be common to have a reaction that can include swelling warmth and redness in the insertion arm in the first 24 to 48 hours after insertion. The recommendation at that time was to observe by measuring bicep every shift and documenting and using ice as needed to help with swelling and discomfort. We have alot of concerns because we know the nurses on the floor do not even alcohol the caps prior to flushing most of the time and really dont care for the PICC properly after placement but we dont have any concrete proof. We try to document when we get reports from patients that tell us that the nurses dont do this but when we confront and educate they tell us they are doing it and the patient was mistaken or didnt see them do it. Half the time we know they arent even washing their hands when they walk in the room to give care!!!! At a different hospital my girlfriend (a nurse also) observed the nurses enter and leave the room to get supplies while doing her mothers port dressing change and not even bothering to take their gloves off and put fresh ones on along with not washing their hands. Now talk about spreading germs. Believe me...we are pushing for 2 to do PICC insertions but keep butting heads with our supervisor. I have gotten alot of information or should I say ammunition from this site! I will check out the sites you suggested also. Thank you. As for dressing changes we use a gauze dressing and change in 48 hours. We Chloraprep (which I usually do prior to PICC insertion and again before I apply the dressing just in case I inadvertantly contaminated something). We have asked for the impregnated one but so far havent gotten that either. Some days we feel we are running into a brick wall..literally!

Because in our hospital we are the easiest to blame and no one else wants to take the blame. It is a sad situation really and very frustrating. We have been trying for 2 years to get our team up and running. We average about 40 PICCs a month with 5 members on our team. But there is a big mistrust because we come from homecare and are not "hospital" employed. It has been a real struggle.

I always go down to x-ray and read the tip placement with the radiologist. Then if it is malpostioned we can discuss options and I also know what he is looking at. It really helps alot. We have to take a course to be able to read our own tips. But it would be nice to be able to start therapy and not wait. After all I can see if it goes up into IJ or down into SVC and have learned enough standing beside the radiologists to know approximately where my landmarks are and if I am in atrium or lower SVC, but I still would want a radiologist to back it up because even they have been wrong on occasion!

Need some advice. My team has been having a recent problem with PICC infections lately. My question is when the cultures are coming back negative are the floors getting excited and pulling PICCs that are only showing a reaction and not an infection and how do we educate them on the difference. (they rarely listen anyway!) I know sometimes the only way to tell is to pull and culture but that is really distressing for the patient. How long after a PICC is placed is it an infection from being placed? How long after placed is it infection from how the floor manages it or the fact the patient has a severe infection to begin with? We do not go back and do the dressing changes or cap changes at this time. (we want to but our boss wont let us). We also use only one person to start PICCs not 2 like most teams I have read about. Thanks in advance.