piccme

How did you get accounts when you first started your business? Is insurance for LLC through NSO adequate? How did you know what to charge? Did you supply your own piccs? Did you use tracking devices to ensure placement? What about cxr's for tip placement? Who pays for that? Help me, pleeeeease! Mary

Hi everyone! I've been putting in PICCs at the bedside for awhile now and its time to start my own LLC. I am having difficulty figuring out how to get this done. I need accounts! I have come to understand that for nursing homes, I probably need to go through the pharmacy, but I don't know what to expect as to payment. I also am unsure as to the approach so they would use my services. I also think I want to service the smaller hospitals who cannot afford to have a picc team. Then, there is oncology where piccs are being used more and more, as well as home health. I want to do piccs wherever they are needed. I'm ready to go LLC but I need to know about pricing and acquiring accounts! Can anyone steer me in the right direction? As always, thanks for your help!

I've heard that it can take Medicare up to 6 months to pay. But if you go through a Pharmacy, and they bill it, its a lot easier on the nurse. I don't know yet what all of this involves, I've been to busy at work and working on prep for the CRNI exam coming up. I'm sure the pharmacy would want a cut of the profits, but I'll find out more hopefully soon.

so....how difficult was the CRNI exam? I am scheduled to take it in September and more than a little worried as my entire experience before I became the only PICC nurse for our hospital is in Cardiology. Technically I am pretty good...... cath lab/ir took care of that aspect for me. I went to a 3 day review seminar last month that BLEW MY MIND! Any tips??? I sure would appreciate it! Mary

I, too, have been looking into my own business for placing PICC's in the nursing home, home, where ever! I have found that I should become an LLC from my attorney and am currently having a seach done for my business name, its cute, but sorry, I can't say it yet! Besides that would be a jinx! My understanding is that dealing with medicare is a pain and that the other picc nurses that I met at a seminar to take the CRNI exam go through the pharmacy of the nursing homes they deal with and they will bill for you! for a piece of the action, I'm sure, but I plan to find out how much they want. With the healthcare changes on the horizon, and some already happening, it makes sense. I am clearly going to start converting over to my own LLC and away from the hospital setting over the next two years. I am also taking the CRNI exam in September as it will add credibility..... wow, there is a lot to study! HAHA! But I will study and figure it all out! I could use any experienced tips towards my future too, its been a difficult process to find out the information I have already and I expect it to become more difficult along the way. Its a new business for me, and there is much to learn!

I would really appreciate a few articles on this! At my hospital, I have orders for hep flushes and the hospital is questioning the need for it. I find it keeps piccs working optimally longer.

When I first started doing picc's I wish someone would have told me to insert the wire slowly. It won't get hung up that way.

Thanks for the helpful hints, its most appreciated! Mary

I've only been putting in PICCs for a year. I have put in over 500 in such a short time....and we're a small hospital. The need is just so great. I would recommend calling Bard.... they come out, free of charge and work with you for as long as you need them. they follow up regularly and are a great assistance! In time, you will be a great picc nurse! Hang in there..... its worth the effort every single day! I have placed in Piccs in patients that have pulled theirs out in the same arm without a problem at all. I have also used the brachial vein when necessary, I, actually, don't find it all that difficult anymore. I use what is there. We arent placing piccs in people who have good veins, hence the great need. You use what is there, in reality. Take your time, read a lot, have confidence in you! You'll get there. Mary

I went into the left basilic vein, which was larger that what i usually deal with. No history of surgery, pacer or ICD. It was a 6 fr picc. The picc wouldnt flush after placement, nor was there a blood return. I pulled it back, thinking maybe there was a kink. It still wouldnt flush, so I decided to swap it out. I cut the PICC and rewired it. The wire wouldnt advance as it should have, based on measurement. It wouldnt come out of his arm, so I decided to get an xray. The knot was nearly 3 mm.

Along with my PICC responsibilities, I do a few other things at my hospital. One of them is to teach IV's. This all sortof came about as I tend to be a pretty good stick and people would ask me to start theirs or teach them how i do it. I was formally a cathlab nurse for many years, and we just started a lot of iv's. Now I teach it. RN's typically get very little education regarding sticks. I think if you find a nurse at your hospital who has the knack for it, hang out with her for a bit, you'll pick up on it. After that its just a matter of acquiring the skill and using it. If you don't use it, you'll lose it! Have a great day!

I've been putting in PICCs for nearly a year now. Yesterday, the darn thing tied itself in a knot about an inch from the tip! I couldnt remove it from his arm, so the patient had to be sent to IR to have it snared. The PICC went in so easily, didnt get hung up at all, and it was a straight shot down the svc. Has this happened to anyone? Mary

I use the Sherlock with every insertion. I wouldnt want to do piccs without it, actually. I know exactly where my picc is all the time. Bard has a deal with the shelock, our initial one was 1500, but if we maintain 40 piccs a month they will reimburse us the full cost.

I always go with the triple lumen in either the ICU, OR, or ER. I really dont put in any single lumen PICCs, even on outpatients as they are usually either on more than one abt, or lack of trust in the flushing. I find they dont come back as often with a clogged port. I am using more and more 6 fr piccs. I am also changing over our hospital to positive pressure caps.... and hoping it will help out my problem with sluggish ports! I just keep hoping.,..... lol

I'm glad I could add to the discussion. I think its great to have a place to come and discuss the PICC biz! There arent that many of us out there yet, yet being the keyword! Mary