I have been asked for either a policy or protocol document for patient assessment. We are a small community hospital that does not have physician support for PICC placement. Currently when RN assesses patient as a poor candidate the patient must be transferred to another hospital in system for procedure. We also do not use U/S as a placement aide due to cost of equipment. The RN documents patient's potential candidacy in progress note for ordering physician. Is that enough? If someone already has a tool they use I would appreciate sharing document.
Without using US, you are severely limited to only those veins that you can see and/or palpate in the antecubital fossa. The other factors to be considered include paralysis of the upper extremity, history of mastectomy, renal failure or impending renal failure as determined by creatinine, ortho or neurological problem with extremity, etc. But without US, who is paying for the transfer to the other hospital? It sounds like it is the patient or a third party insurance company, so your hospital does not feel the financial loss when they must transfer a patient. How often does this happen and what amount of money is your hospital loosing due to this transfer? Your documentataion of the patient's candidacy is certainly enough, especially since your hospital will not provide the proper tools for you to increase the number of patients that are candidates. If you cannot see or feel a vein you feel comfortable with, it is your professional responsibility to refuse to attempt and to document your assessment and your professional judgment. Making attempts blindly when you have doubts about the success can lead to complications such as nerve or arterial damage. So your response should be a firm, but professional refusal to make the attempt. The indications and contraindications for a PICC should be included in a PICC insertion course but I have never seen these factors converted to an assessment tool. Go back to your original education, pull that information and create a tool that works. Sorry I don't have one to share. 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
Totally agree with Lynn that without US, you are severely limited in placing. I was interested in your comment about "small hospital" because I have many small hospitals that still have in house nursing based vascular access services. I would think the cost of transferring patients and the benefits of better outcomes overall would be a factor in convincing management to provide the tools you need.
You can write to me off line if you want to explore some options for creating an in-house service. [email protected].
Ultrsound equipment is costly but what are your doctors using when they place central lines? Can you not share equipment with them? That is how we started out many years ago. I believe the standard for physicians require ultrasound use for central line placement so there should be machines in your facility. Do you have a medical director? Is s/he on board with improving your service? We just ordered a new Sherlock with 3CG tip placement and it was under $30,000. I don't know what the cost of transporting your paients is but it is likely $500-$1000 a transport plus the cost of paying the other facility to do your job. Gather those numbers and present them. Most finance people jump at the chance to save money, increase revenue and increase patient satisfaction. Good luck!
I neglected to add that I am at a rural hospital and did fight that uphill battle to win over the doctors. If there is anything I can do to help you please contact me at [email protected]