Our PICC team is hoping to replace our current tip positioning system (Sherlock) with Sapiens or Vasonova. This will depend on being granted funding in the next capitol budget. Our question is to those who HAVE elimated the need for chest x-ray with these devices to confirm tip placement. Where exactly does to "permission" come from? Hospital administration, Board of Nursing, Medical Board?? Who or what is qualified to allow the elimination of the chest x-ray?
Thanks for your input.
Siri
New Hampshire
This is a standard of practice issue and there is no "permission" to be granted from any organization or regulatory agency. This is a decision to be made by appropriate committees within your facility after careful evaluation of the technology, collection and analysis of your internal data, and assessment of the published evidence. When the INS Standards Committee finalized the content of the 2011 edition in the summer of 2010, there was not adequate evidence to change the standard for a chest xray at that time. The ECG technology is showing great results and is probably much more accurate than a chest xray, however there will always be a subset of patients that will continue to require a chest xray. Research has not completely established which patients are in this subset, and we definitely need more published outcome data. Therefore the standard remains a chest xray. There are some hospitals that have collected their own internal data, identified patients in their populations that still need an xray but have eliminated the xray for the majority of patients. So this decision is made by each facility based on the published evidence, the data you collect internally, and the manufacturers instructions for use, which has been cleared for market by the FDA. So do not expect any board of medicine or nursing to make any formal statements about this. Your hospital administration does not make these decisions either. It will be made by the committees involved with vascular access practice in your facility. This does mean that you will have some homework to do to collect the evidence - both published and your own data, write your new policy, procedure, and practice guidelines and then send it to these appropriate committees. 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
First off the original order to x-ray a PICC for tip positioning was a medical order given by a MD, PA or ANP. It was likely your insertion procedure that was approved by your hospital medical board
Chest x-rays are not ordered by a RN but ordred by a MD, PA, APN. State Boards of Nursing have nothing to do with medical orders and an x-ray is a medical act and order.
To remove the need for x-ray or alter wording of a current order set, policy, procedure one must go to the governing board that approved the original order set, policy or procedure to get the change. Having articles and side by side data is usually what one takes to the committee to get approval for change as well as a list of hospitals who have altered their policy for x-ray in your area.
Hope this advice helps
I once again work for a manufacturer and am biased
Kathy Kokotis RN BS MBA
Bard Access Systems
"side by side data is usually what one takes to the committee to get approval for change as well as a list of hospitals who have altered their policy for x-ray in your area."
Perhaps those that participate in this list serv who have "altered their policy for xray" could identify themselves and assist those of us who are beginning this process
Thank You in Advance
Robbin George RNVA-BC Vascular Access Resource Department Inova Alexandria Hospital Virginia USA
Robbin George RN VA-BC
We started this process in April of this year. We had approx. 2 week training time for our staff of 6. Prior to starting I met with our intensivists group. I discussed with them my plan of comparing chest x-rays with the Sapiens system for 60 days. They felt this was adequate. This was enough time for our staff to become comfortable with the equimpment and also our confidence level grew over this time. I would then meet with them in 2 months and discuss the data that I had collected. I also spoke with the chief of our radiology dept about the plan we set forth. I would also update them after the data was collected. During those 60 days I was developing our policy and a new order sheet to reflect this process. Also during this time, I would speak to other physicians in our hospital and make them aware of the new system. The data from the 60 days was presented to the intensivists group in Aug. We were given the approval. One request from them is that we continue to track ICU pt. if they have had chest x-rays the following day(not for PICC placement). This will be ending soon as well. This was viewed as a quality improvement project. We have been chest x-ray free(when able) since then. Our new policy and procedure and order sheet went through our shared governance pt. care practice council. Communication to staff, physicians and radiologist is important.
Karen Ratz,RN, VA-BC Unity Point St. Lukes Hospital, Cedar Rapids,IA
Our first step was gathering vendor and independent research/statistics that support the new practice. Then author your proposed new policy. The new policy will cover the definitions for the proper FDA cleared use of ECG and/or xray. This should be driven by the manufacture’s IFU along with the research. I also created a one page summary sheet for the meetings showing how the technology works and the physiological and financial benefits.
I would highly suggest setting a meeting with your nurse executive if possible to share how you can improve patient outcomes and save the hospital $xxxx at the same time. The number one reason for failure of any project is lack of upper management support. The more they are on board with a project, the easier it will be to accomplish.
We changed from Sherlock to Sherlock + SAPIENS in April 2011. Our facility approval process involved 3 committees: 1) Nurse Practice Committee: for change in nursing practice. 2) Medical Executive Committee: for change in nursing practice. 3) Product Committee: for use of a new product.
Good luck :)
Kevin Arnold RN, MSN
Our first step was gathering vendor and independent research/statistics that support the new practice. Then author your proposed new policy. The new policy will cover the definitions for the proper FDA cleared use of ECG and/or xray. This should be driven by the manufacture’s IFU along with the research. I also created a one page summary sheet for the meetings showing how the technology works and the physiological and financial benefits.
I would highly suggest setting a meeting with your nurse executive if possible to share how you can improve patient outcomes and save the hospital $xxxx at the same time. The number one reason for failure of any project is lack of upper management support. The more they are on board with a project, the easier it will be to accomplish.
We changed from Sherlock to Sherlock + SAPIENS in April 2011. Our facility approval process involved 3 committees: 1) Nurse Practice Committee: for change in nursing practice. 2) Medical Executive Committee: for change in nursing practice. 3) Product Committee: for use of a new product.
Good luck :)
Kevin Arnold RN, MSN