Published Mar 22, 2001
MD has declared RN may not insert PICC using Seldinger technique. NP or PA may.
What is the decision of other boards?
I am a PICC certified RN and have not heard of "Seldinger" technique. Could you fill me in?
Regarding the use of the Seldinger method for PICC inserton, we are currently looking at the Site Rite from Bard. It requires the use of the Seldinger technique.This is basically insertion of a microintroducer to cannulate the vessel. A guidewire is then threaded into the vein. The microintroducer is removed, a small nick made into the skin with a blade to allow for introduction of a larger catheter into the vessel through which the PICC can be threaded.The Site rite actually guides your puncture as far as location, depth, etc. This technique is used frequently by physicians all the time for insertion of central lines. Might it be that the MD's toes are feeling stepped on? It never occured to me that an MD would object or that a ruling from the State Board would be needed. As long as the person doing the procedure has been trained with documentation to support that. Of course there will be a learning curve with our IV RN's as they learn this technique, but I feel overall,this technology will allow RN's to provide user-friendly,cost effective and better tolerated IV procedures to patients.
Site Rite from Bard does NOT require the Seldinger technique. Can be used prior to stick to locate the vein or mid-procedure
to locate vein & your needle. Needle guides are then not used & the sterile sleeves are $65./box of 10 vs $120./box with needle guides.
Originally posted by acree:MD has declared RN may not insert PICC using Seldinger technique. NP or PA may.What is the decision of other boards?
We have been using the Modified Seldinger method of PICC insertion since January 2001. Prior to implementation, the State Board of nursing was consulted and then the procedure was presented to the Chief of Surgery who approved of this technique. This was then presented to the Medical Director who took this to the Medical Executive Committee and Clinical Practices Committee who gave the final approval. Our Medical Center is comprised of two divisions totaling 500 beds. The smaller division of 120 beds has five nurses certified in this technique three working both the IV department and the Medical Day Stay department. The larger of the two divisions have four full time IV nurses with an open part time position. I do not feel that all RN's should be permitted to insert PICC lines using a conventional method or the Modified Seldinger technique. There should be a limited number of RN's with excellent venous access skills selected to insert PICC lines.
My understanding is that NH says 'yes'. We recently had an issue with RN's performing microbore insertions at our hospital while inserting using flouroscopy in angiography and decision per the board was "yes". Although this is a little different than modified seldinger (that is how I know it). To my understanding modified seldinger is an approved method of insertion per INS. Modified seldinger is a great option, if approved, as you can get higher up on the arm and usually avoid the bend of the arm where the pumps frequently will alarm when the arm is bent. Alot easier on the patient as well.
I have been using the modified Seldinger technique for 8 years. There is never a question as 8 years ago we went to the State Board and asked for a declatory ruling on PICC insertion and stitching. The ruling was granted and the nurse could decide which technique was best if she was verified in PICC insertion and had demonstrated IV excellance by meeting performance standards set up by the hospital.
COlorado can place using modified Seldinger tech.
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