Nurses visualize PICC catheters, enabling them to deliver on-time medication administration
TEAM: Vascular access (PICC) nurses
ENTRY SUBMITTED BY: Lorri Jameson MSN/Ed, RN, VA-BC, nurse team lead for PICC
When a patient enters the ED or is admitted to the hospital, it is likely that some type of vascular access will be needed at some time during their stay. This can be one of the scariest experiences a patient has during their stay, and is often a source of patient dissatisfaction.
At Memorial Hospital UCH(MH-UCH), patients don’t have to worry: we have a dedicated team of expert vascular access nurses who are trained to use ultrasound guidance (as well as other advanced technologies) to place PICC lines and midlines and assist with difficult peripheral IV insertions as well as difficult lab draws, which helps alleviate our patients’ fears.
The nurses at MH-UCH are dedicated to providing the most up-to-date, evidenced-based protocols whenever possible. This is done by attending continuing education classes, going to conferences and through networking with peers. Our team, which consists of 5 full-time and 2 part-time RNs, covers 2 campuses consisting of 683 licensed beds. We are often consulted by physician offices, long-term care facilities and rehabilitation centers to place lines in their patients on an outpatient basis.
We are currently using a system which allows us to visualize the PICC catheter as it moves into the chest and down into the SVC, along with ECG technology that we use for placement verification. This enables us to trouble shoot any problems while we are still sterile, as well as release the line as soon as the procedure is done. This prevents delays in patient care and allows patients to receive on-time medication administration.
Our team was the first team in the United States to use ECG technology. We were the 9th hospital in the U.S. to become “x-ray free” after using ECG technology, meaning we can clear our PICC lines using only the ECG technology, which saves the patient from radiation exposure emitted from x-rays (as well as saving both patients and our organization the added costs). This also has the added benefit of freeing up our radiologist to read diagnostic films such as CT Scans and MRI’s.
The average cost of having a patient get a central line associated blood stream infection (CLABSI) is between $30,000 to $60,000. Because CLABSIs are considered to be hospital-acquired infections, which could be reasonably prevented using various infection prevention techniques (such as performing hand hygiene, thoroughly disinfecting the needleless connector, and maintaining a sterile technique), they are not reimbursable through Medicare/Medicaid and many other insurance companies.
We do all the PICC line and midline dressing changes throughout the facility, as well as provide regular education to the hospital staff regarding vascular access issues. We round on all our patients that have PICC lines to assess for patency and continued needs, which has resulted in a zero infection rate for greater than one year, thereby increasing both staff and patient satisfaction.
Our team is always willing to go the extra mile to ensure that the patient is getting “the best line at the best time.” We have developed outstanding relationships with physicians and nurses throughout the facility. We have many patients who ask for us by name to start their peripheral IV’s, because they know it will be done painlessly and with very few attempts.
We have memberships in the Infusion Nurses Society (INS), the Association for Vascular Access (AVA), and the Colorado Vascular Access Network (COVAN). Two of our team members have held the Vascular Access Board Certification (VA-BC) for more than 6 years. This team of nurses is exceptional in knowledge and expertise, and is continually researching ways to improve our patients’ experiences here at MH-UCH.