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How to Improve
PICC Insertion Techniques
Practice makes perfect,
and PICC insertion specialist know this to be quite
accurate. While the majority of PICC insertions are
straightforward with some training, it's the difficult
ones which need experience to master.
A difficult PICC insertion
may include any or all of the following
The Difficult Patient:
Typically difficult
patients are encountered in neurology, psychiatry, pediatrics,
elderly care and even patients in routine units making
it, at times, extremely difficult to attempt any type
of catheter placement. At times, it is even seen in
patients who are unconsciousness or sedated who react,
sometimes violently, to outside stimulus such as to
pain, touch, or general care.
The Difficult Arm
and/or Vein:
Sometimes even the most
patient and cooperative patient has a difficult arm
or vein to access. As anyone who has inserted PICC's
knows, some arms are almost impossible to insert a PICC.
Obesity, burns, friable veins, bleeding disorders, thrombosed
veins are conditions which make placement challenging.
In addition, placement of pacemakers, current or previous
port placements, dialysis or mastectomy patients are
situations encountered where extremity selection is
hindered eliminating 50% of possible options.
Specialized Situations:
PICCs are being used
more in specialized settings and situations than ever
before. Therefore, as the patient population changes,
it requires experience for nurses and physicians to
become accustomed to the intricacies pertaining to that
populace. Cases involving pediatrics, burn victims or
trauma patients may, comparatively, take more time in
which to become proficient due to their difficult clinical
presentation.
Therefore, rather than
delegating it to the "'occasional cannulator", an excellent
strategy might be to employ full-time PICC nurse specialists
who gather the expertise associated with PICC placement
in a broader range of patient populations and underlying
illnesses. In particular, with relation to the above
areas of difficulty or specialization, such a professional
is likely to provide excellent service and cost-effectiveness
for any institution.
Such a model has been
reported recently(1) from a full time vascular access
nursing service (VANS). Outsourcing has many multi-disciplinary
approaches such as:
- -improving relationships
with overstretched departments who are often requested
to provide difficult vascular access, for example
interventional radiology, anesthesia;
- -streamlining the
entire procedure of vascular access, administering
therapy, monitoring, replacement, treating complications;
and
- -billing and providing
ongoing training for other workers in developing their
skills, particularly for the less difficult cases.
While many health care
institutions and agencies appreciate and demand PICC
lines insertions to benefit their patients while providing
cost effectiveness, maintaining a fully trained team
of professional inserters is often impossible. Outsourcing
PICC lines inserting services provides benefits of fully
trained professionals, ability to cannulate the most
difficult cases both of which result in increased patient
satisfaction and cost effectiveness by freeing other
departments for other procedures.
Reference
(1) Falkowski A (2006) Improving the PICC insertion
process. Nursing. Feb2006, Vol. 36 Issue 2, p26-27
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purposes only and is not a substitute for medical advice
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