Part of the duties of our Vascular Access Team is to provide education/training to new staff who have not had training on inserting periheral IV's. I am looking for feedback from anyone who has similar responsibilities and what your guidelines are for training. Are there any INS/AVA standards? I have looked and cannot find any. Thanks in advance for any information you can share.
The INS Standard that would apply most is # 6 Competency and Competency Validation.
There are other standards for the educational process, etc. from the Association for Nursing Professional Developmet - www.anpd.org.
There is also a national certification in nursing professional development from ANCC, one that I have held for many years now.
You will definitely need a program to valid competency and document it for each individual's file. Instructors must have a validated competency in the procedure/intervention they are assessing in others. Joint Commission requires such a program of competency validation. Also books on competency discuss a competency assessment program in 2 phases - initial and ongoing.
The emphasis is not placed on the activities of teaching, but on the process of learning. This shifts the focus and responsibility to the learner. You may need to have a formal class, which could be in a traditional classroom or via an online learning process. Then you will need a skills lab to practice ONLY on anatomical models. See INS #6, Practice Criteria H. Following this step, each learner will require supervised clinical practice. Choosing well-hydrated, well-nourished adults with good veins is the place to start. Your faciility must decide the number of successful PIV insertions before allowing the person to practice without supervision.
Finally, you will need updated, accurate policies and procedures about all aspects of infusion therapy as identified by the INS SOP. When learners have questions they must have a good resource to go to.
My company has an online course, Peripheral IV Therapy in Adults, that focuses on the knowledge and critical thinking required. The psychomotor skills come in the skills lab and supervised clinical practice.
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
Recieved a pt from another facility with PICC in place over weekend. Floor nurse noticed edema in arm so had DR order u.s. U.S. documented small thrombus in mid-distal cephalic vein.
Problem is....PICC line was placed in basilic vein. I even called the inserting facility if they attempted cephalic and the answer was no.
How could this be and how do we treat it??
could it have arised from prior peripheral attempts?
My thought was......upon my arrival no signs of any edema , redness , warmth or any symptoms. ( I do know thrombus's can be silent, and obviosly someting triggered the nurse to do the u.s., but now it is improved) Since the thrombus is in a different vessel, the picc line is not irritating that vessel or thrombus in any way, the throbmus is not in a deep vein and to keep the current PICC line and continue to monitor for any symptoms or increase in thrombus size.
thanks for your help in this matter, Gina Ward
Gina Ward R.N., VA-BC
The word "distal" and "proximal" is always confusing. By mid-distal cephalic, do you mean distal as in the lower forearm? Or distal as in the end of the cephalic vein that joins the axillary vein in the midclavicular region?
If the thrombus was somewhere in the forearm or even above the antecubital fossa, it could have been caused by previous peripheral punctures or catheter sites.
If it is located near the junction of the cephalic and axillary vein, it could easily be caused by thrombus propagating from the axillary vein into the cephalic vein. The PICC passes from basilic to axillary to subclavian, to brachiocephalic, to SVC. I have seen a case where thrombus was found in one of the brachial veins but the PICC was in the basilic vein. Thrombus can grow or propogate into any direction.
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
Gina Ward R.N., VA-BC
Part of my job responsibilities includes teaching the new home nurses in all things infusion during orientation. I lecture them on vein anatomy and so many other things, more than just putting the needle in. I also then teach them how to start and tips for success. We do practice sticks on a dummy. (I'm not the dummy...g) They always know they can call me if they need. We don't see many peripherals in the home, unless its for a short term therapy like Solu Medrol. I am not aware of any standards concerning this, but Lynn would be able to recite it if it exists. I would be happy to discuss further with you and see if any of my info would be of help. No point re-inventing the wheel. Get in touch with me at [email protected] if you want more info.
Good luck!
Ann Williams RN CRNI
Infusion Specialist
Deaconess Home Services
Evansville, IN