Re: Productivity for PICC dressings

[Elizabeth Harmon]

In reading this question I was amazed what people are attempting to do in short amounts of time.   In our facility we are strictly a consult service and we allot approximately 30min for a consult.  This is after we have recieved the faxed consult from the floor RN or physician.  We do a thorough chart review of past possible PICC's, current medication, disease process, current VAD, assess the patient with ultrasound. Chart our findings and contact the Physician with them.  If there is an order for a PICC and the patient is "PICCable" then we proceed at our earliest convience.  We have 24 hours to respond to the consult.  Most of the time we are able to get the PICC placed that day or within 24 hours.    The time for placing a PICC varies as with each patient.  I have spent 3hours attempting to get the PICC into the Dist SVC only to have it go up the L and R jugular and then cross over into the opposite SC.  We do not limit a time to place PICC's.  Because we have all necessary items on the Acute care floors to place PICC's we just acquire the items from the Pyxsis.  Obtaining consent sometimes can be the hangup because if family is not in the room you have to wait for them.  Once consent obtained, get supplies, sterile field, etc.... Get xray for a STAT PCXR (that's where is can be a problem).  They usually respond to ICU faster than the floors and if you are on the floors it sometimes can take a while.  We have managed to deal with this by getting to know our xray techs.  Contacting them just prior to attempting a PICC and let them know they are going to be beeped for this room.  This has helped immensly.(?sp)?    Finishing up the paperwork and making sure all the orders are signed and filled out correctly. We have a pre-set of flush orders for NS and Heparin Flush of all our VAD's to which once the Physician say's ok to distal tip placement we sign a verbal.  We also remain in sterile garb until the PCXR is read.  Our physicians/residents/PAC's all know that we cannot wait for them to get out of a meeting.  The radiologists also read the tip placement for us and the ER physicians.    So realistically the time spent on the average for placement of a PICC is about 2 hours.  This is addition to the time spent for a consult.    All of our floor/ICU/staff RN's do dressing changes, if there is a problem they send a consult and we then assess what is needed, increased teaching, contacting the MD, placing a different dressing, etc......Our Vascular Access Team is quite atonomous and it works well for our facility.    Contact me if you would like anymore information.   Betsy Harmon RN CRNI Vascular Access Team Critical Care Unit Alaska Native Medical Center [EMAIL PROTECTED] ----- Original Message ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] ; [EMAIL PROTECTED] Sent: Friday, April 14, 2006 9:58 AM Subject: Productivity for PICC dressings Below is a Question recently posted but not answered in full by anyone--There is no way in the real world that a skilled/professional PICC nurse can verify an order--assess the patient for placement appropriateness and anatomical accessabilty--obtain informed consent--measure and prep patient--establish a large sterile field--administer local anesth--puncture and vein capture--MST advancement of catheter--apply sterile dressing--obtain STAT portable--fill out a mound of paper work while waiting for XR confirmation in 30 or 45 minutes--those numbers are totally unrealistic and misleading in the hospital bedside environ where ONE nurse is responsible to do all of the aforementioned steps--and let us not forget to factor in TIME for troubleshooting/complications or repositioning etc....20min for drsg change but 30-45min for PICC insertion??? GET REAL!!!   Robbin K. George RN Vascular Access Resource Alexandria Hospital Virginia ----------------------------------------------------------------------------------     I would like to know from those of you who do picc dressings how much time you get for productivity. Should this time include collecting supplies and charting? I would also like to know how much time you are alloted for PICC placements with ultrasound. Thanks for your help. Darilyn Cole, RN CRNI Mercy Healthcare Sacramento --------------------------------------------------------------------------------- We are allotted 20 min. for central line dressing changes and 45 min. for picc placements in our RVU conversion for productivity.  Cheryl Barrett RN, BSN, CRNI IV Coordinator Erlanger Health System 423-778-2472 --------------------------------------------------------------------------------- We are allotted 2 hours per PICC-  try to place 4 in an 8 hour day, and 6 in a 12 hour day... including paperwork and ordering/gathering supplies. --------------------------------------------------------------------------------- We allotted 30 min  per PICC and 20 min for dressing changes.      Doug ---------------------------------------------------------------------------------