Question 2:
Do you have the numbers to compare the percentage of PICC patients referred
to radiology for PICCs before MST and after? If you do, I think that speaks
volumes. Your referrals to radiology PICC insertion costs much more than
you doing a bedside placement. This impacts the bottom line of your
hospital's financials.
Interventional radiology uses more FTEs (usually) and more equipment on top
of what you used if unsuccessful. Interventional radiology also makes more
money for the hospital doing other more complex procedures, instead of PICC
insertions (low revenue procedure). Our radiologists were very ready NOT to
do PICCs. We used this same type of information to justify MST and then
later, also justified ultrasound machines for the PICC nurses. We went from
45% of all PICCs going to radiology to <9% over the last 3-4 years. Using
this same calculation, you could easily justify the cost of ultrasound
machine.
Data is powerful. Use it to your advantage.
Question 1:
Usually by the time we are called, the patient has been stuck unmercifully.
OK, not always, but we are not an example of early assessment, so we see
this more than we would like to see. But using ultrasound and accessing
veins, we use lidocaine 1% and try to prevent any pain with the needle to
access the vein AND with the nick for the introducer. Our patients respond
that that the use of lidocaine is much easier to tolerate than the "back and
forth" with an unsuccessful IV access. INS standards don't say prevent all
pain, but instead, local anesthesia is not for routine use. (Gee, I hope I
get this right without my standards in front of me)
Gwen Irwin
Austin, Texas
----- Original Message -----
From: "Fry, Cheryl" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Saturday, September 30, 2006 10:15 AM
Subject: MST & sequence of procedure
Hi,
I have 2 questions.
1. When using MST to place PICCS, is it wrong to do the
initial stick with a 22 g. catheter, thread the wire, THEN place the
lidocaine and do the nick? That is how I have been doing it because
previously the lidocaine caused the vein to constrict and I was unable to
get the vein successfully. The way I have been doing it allows me to have
success most of the time. Does INS standards say that we are to prevent
ALL pain? I feel like the pain from the lidocaine is worse than the stick
pain of the 22 g. catheter.
2. Can anyone give me proof that using MST is better for
the patient-I need to be able to justify the added expense to my assistant
manager so she can justify the added expense to the higher-ups. (I know it
is better for the patient and better for me) As I see it, the added
expense adds up to ONE MST kit per procedure-about $30 here. Yet we are
able to place many more PICCS than before using this technique. I hate to
go back to the dark ages. And I don't think we will ever get an ultrasound
machine.
Thanks for your help,
Cheryl Fry CRNI
University Health Care
Columbia, MO
