I was wondering if anyone out there does PICC and IV access or if your establishment has an IV access team . We are currently looking at our PICC team doing difficult IV access.
In my opinion, all teams, regardless of what they are named, should provide all services for all types of vascualr access and infusion therapy support for all patients in the entire facility. That is historically the way such teams have operated in many hospitals and still do. Lynn
We are considering having our PICC Team become the difficutl IV access team for the hospital. I was just wondering if there are other organizations out there who do both?
We do both. I agree completely with Lynn. A Vascular Access Team should provide services for all things vascular but the reality is that many hospitals do not see any economic value of staffing for that service...despite the obvious savings in supply reduction and the huge impact on patient satisfaction as well as consistent application of standards. My team was forced to reduce routine IV placement as we focused more on PICCs. Consequently, we have moved backwards in the quality of care provided as the bedside nurse and others struggle to meet the patient's needs. We do place the difficult PIVs but it may be at any stage of the hospitalization. Unless the family specifically requests us, we may not see the patient until after access has been depleted and/or the patient is quite traumatized. All very discouraging.
Our PICC nurses are the Central Line Team for our hospital. Their role is to insert PICCs, perform assessments of every central line in the hospital on a daily basis, perform all central line dressing changes, assist with CVC insertions, declot lines, and perform difficult IV starts (and many "not-so-difficult"!), often using ultrasound to locate vessels.
They do so many of the IV starts that the majority of staff nurses are no longer comfortable doing their own IVs. We are NOT an IV team, but are certainly is moving in that direction. They are phenomenal in their skills and have excellent patient outcomes. I have been told that many nursing schools are no longer even teaching the insertion of peripheral IVs! So I think we will see fewer and fewer nurses willing to place IVs and an increase in specialized IV teams again.
Wendy I am very curious as to why you say you are not an IV or infusion team when your scope of service is virtually the same as many others who call themselves an IV or infusion team? Infusion team does not indicate that your team nurses are giving all of the fluids and medications. It means you are the experts on it though and the go to person for anything related to infusion and vascular access. The CRNI exam has always contained a significant amount of questions on VA decisions, insertion, care and maintenance. So VA is a subset of infusion therapy, not a separate practice all together. I am now giving a presentation titled Infusion Therapy and Vascular Access- A Marriage of Necessity. If you have no infusion prescription you don't need a VAD. If you need a VAD, there will always be infusion therapy. They can not be separated. Every decision made about what VAD is chosen, how it is compounded and infused, and management of all complications is directly related to the type of infusion therapy the patient is receiving. I just don't get the whole idea of trying to separate them and I strongly believe that this is the source of many problems we now face. Lynn
I hear what you are saying, Lynn. We have a group of nurses who are called Resource Nurses. Their role is to assist all departments with a variety of things - responding to all Codes and traumas, help with admissions, patient education, etc. These same nurses are also the Central Line Team which was established at the end of 2011 in response to rising CLABSI rates. Since then, by the way, we have had only one CLABSI in a patient with vascular lines EVERYWHERE. These nurses also place PICCS and peripheral IVs as I mentioned below. They are not the SOLE inserters of IVs - there are nurses on each unit who are still competent to place IVs and love doing it, and are good at it. I guess that's why we have not considered ourselves a true IV team. But they are definitely the go-to experts in vascular access. By the end of 2012, all of us will be certified in vascular access.
We are a Vascular Access Team. Our priority is PICC's, but we do CL dressing changes/ maintenance, and complex IV starts. Basically we are PICC and IV nurses. I am sure many hospitals do this.
In my opinion, all teams, regardless of what they are named, should provide all services for all types of vascualr access and infusion therapy support for all patients in the entire facility. That is historically the way such teams have operated in many hospitals and still do. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
We are considering having our PICC Team become the difficutl IV access team for the hospital. I was just wondering if there are other organizations out there who do both?
We do both. I agree completely with Lynn. A Vascular Access Team should provide services for all things vascular but the reality is that many hospitals do not see any economic value of staffing for that service...despite the obvious savings in supply reduction and the huge impact on patient satisfaction as well as consistent application of standards. My team was forced to reduce routine IV placement as we focused more on PICCs. Consequently, we have moved backwards in the quality of care provided as the bedside nurse and others struggle to meet the patient's needs. We do place the difficult PIVs but it may be at any stage of the hospitalization. Unless the family specifically requests us, we may not see the patient until after access has been depleted and/or the patient is quite traumatized. All very discouraging.
Our PICC nurses are the Central Line Team for our hospital. Their role is to insert PICCs, perform assessments of every central line in the hospital on a daily basis, perform all central line dressing changes, assist with CVC insertions, declot lines, and perform difficult IV starts (and many "not-so-difficult"!), often using ultrasound to locate vessels.
They do so many of the IV starts that the majority of staff nurses are no longer comfortable doing their own IVs. We are NOT an IV team, but are certainly is moving in that direction. They are phenomenal in their skills and have excellent patient outcomes. I have been told that many nursing schools are no longer even teaching the insertion of peripheral IVs! So I think we will see fewer and fewer nurses willing to place IVs and an increase in specialized IV teams again.
Wendy Erickson RN
Eau Claire WI
Wendy I am very curious as to why you say you are not an IV or infusion team when your scope of service is virtually the same as many others who call themselves an IV or infusion team? Infusion team does not indicate that your team nurses are giving all of the fluids and medications. It means you are the experts on it though and the go to person for anything related to infusion and vascular access. The CRNI exam has always contained a significant amount of questions on VA decisions, insertion, care and maintenance. So VA is a subset of infusion therapy, not a separate practice all together. I am now giving a presentation titled Infusion Therapy and Vascular Access- A Marriage of Necessity. If you have no infusion prescription you don't need a VAD. If you need a VAD, there will always be infusion therapy. They can not be separated. Every decision made about what VAD is chosen, how it is compounded and infused, and management of all complications is directly related to the type of infusion therapy the patient is receiving. I just don't get the whole idea of trying to separate them and I strongly believe that this is the source of many problems we now face. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I hear what you are saying, Lynn. We have a group of nurses who are called Resource Nurses. Their role is to assist all departments with a variety of things - responding to all Codes and traumas, help with admissions, patient education, etc. These same nurses are also the Central Line Team which was established at the end of 2011 in response to rising CLABSI rates. Since then, by the way, we have had only one CLABSI in a patient with vascular lines EVERYWHERE. These nurses also place PICCS and peripheral IVs as I mentioned below. They are not the SOLE inserters of IVs - there are nurses on each unit who are still competent to place IVs and love doing it, and are good at it. I guess that's why we have not considered ourselves a true IV team. But they are definitely the go-to experts in vascular access. By the end of 2012, all of us will be certified in vascular access.
Wendy Erickson RN
Eau Claire WI
We do both US-PIV and PICC. Hope to expand in the next year to IO and US-Central lines.
Thanks,
David
We are a Vascular Access Team. Our priority is PICC's, but we do CL dressing changes/ maintenance, and complex IV starts. Basically we are PICC and IV nurses. I am sure many hospitals do this.