Any of you from large university settings, possibly with multiple facilities??? Do you have teams that do all access...IV, PICC, dressing changes? Did you transition to an all inclusive team from just a "PICC" team? Were there good results or outcomes?
Two hospitals come to mind - Barnes Jewish Hospital in St. Louis and the University of Michigan hospital. Both are large teaching hospitals, both have infusion teams, not just PICC insertion teams.
You should also locate this article:
http://www.ncbi.nlm.nih.gov/pubmed/21460466
Peripherally inserted central venous catheter-associated bloodstream infections in hospitalized adult patients.
Source
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Abstract
BACKGROUND:
Limited data on the risk of peripherally inserted central venous catheter-associated bloodstream infections (PICC BSIs) in hospitalized patients are available. In 2007, dedicated intravenous therapy nurses were no longer available to place difficult peripheral intravenous catheters or provide PICC care Barnes-Jewish Hospital.
OBJECTIVES:
To determine the hospital-wide incidence of PICC BSIs and to assess the effect of discontinuing intravenous therapy service on PICC use and PICC BSI rates.
SETTING:
A 1,252-bed tertiary care teaching hospital.
METHODS:
A 31-month retrospective cohort study was performed. PICC BSIs were defined using National Healthcare Safety Network criteria.
RESULTS:
In total, 163 PICC BSIs were identified (3.13 BSIs per 1,000 catheter-days). PICC use was higher in intensive care units (ICUs) than non-ICU areas (PICC utilization ratio, 0.109 vs 0.059 catheter-days per patient-day for ICU vs non-ICU; rate ratio [RR], 1.84 [95% confidence interval {CI}, 1.78-1.91]). PICC BSI rates were higher in ICUs (4.79 vs 2.79 episodes per 1,000 catheter-days; RR, 1.7 [95% CI, 1.10-2.61]). PICC use increased hospital-wide after the intravenous therapy service was discontinued (0.049 vs 0.097 catheter-days per patient-day; P =.01), but PICC BSI rates did not change (2.68 vs 3.63 episodes per 1,000 catheter-days; P =.06). Of PICC BSIs, 73% occurred in non-ICU patients.
CONCLUSIONS:
PICC use and PICC BSI rates were higher in ICUs; however, most of the PICC BSIs occurred in non-ICU areas. Reduction in intravenous therapy services was associated with increased PICC use across the hospital, but PICC BSI rates did not increase.
No matter how hard we try, infusion services must include the insertion of all VADs along with all infusion techniques. PICC insertion alone is just not enough to ensure good outcomes. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I work at a mid-sized facility on an IV team. We handle all access issues (i.e. PICC placement, IV starts, dressing changes, lab draws from CVC's, extravasation management, ect.). There are certain units within our facility that have beent trained to start their own IVs simply because of the volume needed in those units (ex: procedural labs, TEC). Within the IV team we have a certain number of nurses trained to place PICCs, run our infusion center, and do apheresis. Most of our nurses transition between all the different areas, with the exception of our newer staff still training in one area or another.