1. Try buffering your lido. Add a tiny bit of sodium bicarb (1:10 concentration) to your lido. It will take the burn out. I think it's a crime to insert a PICC without buffered lido. I do all US PICCs, and we go anywhere from 1/2 cm to > 4 cms deep (rare, but it happens). I use a lot of buffered lido and I also numb the top of the skin with 4% topical lidocaine creme before I even start. Most of my patients tell me it hurts less than when a nurse starts and IV.
2. In 2000 we were referring 50% of our patients to IR for PICC insertion. We WERE doing MST, but not US. We saw a total of 700 pts that year; that means IR did 350 patients. They were fed up; no room in their schedule and begged us to learn US.
3. After getting the US machines (capital budget item) and the education/training in March 2001 (thanks to Nancy Mitchell at Albany Medical Center!), we gradually became proficient with US. within 6 months our referral rate dropped to 10% where it has remained ever since.
4. In 2005-6, we did about 1800 PICCs. If we referred 50%, that would mean IR would be seeing 900 PICCs per year!! Think about all the savings we have done for the hospital, let alone better service.
We've been able to justify 4.5 FTEs (although we only were granted 3.8 FTEs), 4 US machines, 3 Sherlocks for our program. We need more, but you need the data to support what you ask for.
Being competent with MST will greatly help you transition to US. One less complicated skill to master.
Nadine Nakazawa, RN
From: "Fry, Cheryl" <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] Subject: MST & sequence of procedure Date: Sat, 30 Sep 2006 10:15:05 -0500 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
