nurhmb

You can check your state practice acts. Ours in PA say no. Here is my very biased opinion on this topic as a nurse in full time action for 27 years. This is an RN skill level procedure that involves assessment, intervention and patient education. Many things can go wrong and you need the advanced skills of an RN. Also, just because someone has a skill does not mean that the patient welfare is being met. Finally, why are you giving up RN skilled pieces that involve assessment, intervention, patient education, trouble-shooting and possible emergency care? Why are you saying that anyone can perform this task? When you give this up you are saying that RN's are not needed or necessary for complex medical care.....bad idea. You are disapaiting our respect and down playing the need for nurses to keep patients alive and well in our healthcare system today. (See the NIH research on this) Do you feel that anyone can perform this skill? Then you have not experienced the issues that can occur. Trust me. Your first crisis will support this opinion. Things can and do go wrong no matter how skilled you are in the process. Please think twice about even considering this option. HMB RN, MSN, CNS, Certified Nurse in IV therapy, long term PICC inserter and educator

There are so many advantages to nursing. I am in a rural area and I have an MSN and work as a CNS and make about that much....I feel lucky. This hospital is one of the few places left where people have steady work, good benefits, health care and the chance at life at retirement. Nursing is stressful. I have worked in jobs in large cities too. I have worked 27 years at this. I have hated it and loved it as a profession.....but what I know is this. Find a job you like, act like a professional and don't whine.....help fix things and you will be surprised how tolerable it is and how much respect you earn. Respect and good benefits are very much worth $20.00 per hour. No job is perfect. My biggest discovery was that my head created my environment. I do think nurses need to work to gain more respect, but I see whining people wanting more and not effective representatives that gain respect from the people who count.

Are you just involved with PICC stats or do you also get involved with other central line stats? How many outpatient PICCs do you see, say, in a month (just curious). Your job sounds sort of like what we had visualized might be a full time position. Who does your back-up? You sound almost like a modified IV team of one. Your hospital is lucky to have someone like you with your skills who likes what she is doing. Your feedback is very helpful. Thanks.:balloons:

I agree that a PICC is not an emergency intervention. I am assuming that you do not do PICCs on weekends. What are your Mondays like? How big is your hospital? Are you doing the 24 hour and regular dressing changes consistantly? Who handles the Friday patients dressing management? What would you do differently if you started the program again? Your insights are helpful. Thanks. :idea:

The Friday afternoon PICC seems to be a common problem. Unless you have a 24/7 team, someone has to hang into Friday night etc. We are looking at admission criteria (Atlas Computer Program) that might ID patients who should have PICC from day 1 because we know that they will have prolonged IV's...osteos and such .....in order to id some of these people earlier in the admission and the week. I don't know if we would then approach the MD for the order or if there would be some kind of automatic ok obtained from the physicians so it was could be initiated by protocol. We are trying to figure out how a smaller hospital maintains more than one position and back-up for PICC insertions and what "the rules" need to be on this to be the most effective for patients but also the PICC nurse. Physician education is a huge issue. I have made a joke that one of the critieria for a PICC should be the physician does not want any pages. If we put that as number one, we would get everyone on the day of admission. :)

It is my suggestion that if a nurse who witnesses these behavours perfrom a quick check of state practice acts. If staff are not within their state "job descriptions", there could be hell to pay when your certifying organizations come through or get a report from someone. In our state, the Dept. of Health would definitely not be happy. Afraid to work within the walls of your institution through proper channels? Contact your state health dept. or JCAHO anonoumously. But stop this madness for the sake of the patient....who could be someone you love or you yourself. Did you ever hear the phrase too stupid and arrogant to know they are dangerous?

I have been PICC certified since 1990. There is a learning curve with this skill and it is not as easy as it seems at first.......you do not become an expert overnight. The overall basic knowledge base is big and things like troubleshooting and the little tricks that make the insertion a positive experience for the patient and inserter come from practice and time. I am not discouraging anyone, I just want nurses to understand that this is a higher level skill than putting in a peripheral and that you all have a license to protect as well.

Go to the INS (Infusion Nurses Society) Website. There will probably be links to companies who educate in PICCs there or some way to find someone. PICC's are not exactly just long IV's. There is a fair amount of things to know to be considered experienced.

I have been PICC certified since 1991. Inserting and maintaining PICC's is really sort of an art and experience is a big part of doing this well. I am having a little trouble with the cavalier attitude that you get certified and go off as an independent practice. Are you certified in intravenous therapy ?CRNI or anything that indicates advanced IV skills? How are you going to defend yourself in court when you have put in 6 piccs and they ask why you are an expert capable of marketing this skill?

Tell me about your position. What hours and days do you work, who is your back-up, how are patients referred to you and by whom, how big is your hospital? We are discussing a PICC nurse to place piccs with US or flouroscopy as needed. How many do you place, say, a week. Who is your boss?

Thanks for the idea of the disposable for the crash carts. We are a small community rural hospital and when the time comes and we get our first power injector, I am sure it will go to the ER.....but I will start awareness on power injectors now for the future. The respones on this question have been very helpful.

Thank-you so much. We need to look into this piece of equipment. Do you know how I can contact someone involved in sales or manufacturing of this product?

Please tell me what brand name rapid infusor that your facility uses. How fast does it deliver fluids? Thanks for responding.

We are a hospital ICU. In occassional situations we need to run in fluids extremely fast in a minimal amouont of time. We have gone to putting a pressure bag on a bag of fluids and running it wide open. Our pumps only go to 999cc/hr. which is a liter in an hour and will not meet this emergency situation. As a result, we were wondering if the rest of the country kept pressure bags on their crash carts, ran fluids fast other ways, or whatever. Thanks for your response

We have a need to be able to provide fluids very quickly in a code situation. At present we have been running a bag of fluid with a pressure bad on it so that we can get max fluid in minimum time. How fast does the rapid infusor get in fluids in cc's per hour. Thaks so much for your response. It is so appreciated. nurhmb