Forum topic

Short answer:

No matter what literature you find about either method, you cannot observe yourself and your sterile field alone.  You need to have a qualified assistant trained in sterile technique that can complete the checklist. 

I know many hospitals don't provide financial resources for this - it is something to strongly lobby for.

 I agree with Mari. I am not sure you will find any studies about this issue, but you can not do your own checklist or meet the patient's needs while you are in sterile attire and doing the procedure. Do you ever see a physicain go to place an CVC without assistance? Lynn

I've written a blog which I plan to post soon.

Here is my summary for justifying a two RN team.

A two nurse PICC team saves money for the following reasons:

·         Fewer supply costs related to low failure rates and repeat procedures.

·         High success rates lead to fewer referrals to interventional radiology.

·         Better outcomes mean fewer dollars spent on treating complications.

·         Increased patient satisfaction leads to better reimbursement and improved risk mitigation.

·         Employee satisfaction means low turnover and fewer costs associated with training new staff.

If only a checklist was mandated and not an option

I believe that the best facilities use a checklist for central line insertion and a checklist is defined as one that is performed by an observerer and does not have to be a nurse or doctor but one that understands sterile technique and breaks.  The individual performing the checklist may stop the procedure at any time for a break in technique period.  The checklist individual is likely the one to control room traffic.

How does one perform a checklist individually and how do you actual observe when alone and empower yourself to stop the procedure you alone are performing?  It is as stupid as it sounds

The is why I would see the need for a second person in the room

It is a shame is not not a mandatory suggestion by any governing body but only a recommendation.

Kathy Kokotis

This is such a hot issue. We know that all insertions should include a checklist and that one person cannot observe their own sterile compliance but PICC teams are unable to justify to medical executives that this practice benefits outcome. How do we get past the cost of the observer? We assist in physician procedures but are left alone to do ours. I don't think its evidence you are looking for, its a culture of patient safety.

Search evidence for use of TIME-OUT for surgical near misses. There is also a lot of evidence to support a checklist(which requires a second person)

 It's helpful to have a second person to assist with patient repositioning when there is difficulty advancing the picc, or if patient gets restless, etc.   Having a trained PICC nurse to assist is even better, because they can try if one is not successful.  This has saved a procedure several times for me, as I have helped others too.  Especially with sedated patients, you don't want to stop and then have to wait for another person to come in the procedure.  Of course, administration sometimes insist we just do it alone because they think it saves money.  It doesn't necessarily save time or money.