Development of a Successful PICC Insertion Program

Abstract

N ationwide, hospital administrators are looking for methods to contain costs as a result of reimbursement decreases. Where N teams exist and budget cuts become necessary at a medical institution, usually the N team is the first to be cut. Valley Lutheran Medical Center (VLMC) is a 237-bed urban hospital that serves a high percentage of Medicare patients. The nursing staff performs all aspects of N therapy, but it is not feasible to train every registered nurse to place peripherally inserted central venous catheters (PICCs). 111erefore, an Ambulatory Treatment Unit (ATV) was established as an outpatient N therapy clinic where nurses were trained to perfOffil PICC insertions. The nurses in this unit already were proficient in peripheral IV catheter insertion and management of central venous catheters, so the addition of PICC insertions was not considered to be a problem for the nursing staff. After the nurses were trained and began performing PICC insertions, the excellent outcomes and low costs associated with nurse placed PICC lines contributed to increased orders for the placement of PICCs by physicians. Case managers also encouraged physicians to order these lines due to the cost savings. During this same period of time, the ATU was discovered as an excellent alternative to homecare and the number of PICCs placed and the patient volume of the ATV increased simultaneously. At the same time, physicians in the radiology department started inserting PICC lines, but VLMC did not have an angiography suite and they preferred not to insert these lines using fluoroscopy equipment. Scheduling conflicts arose if the nurse could not place the PICC and the patient had to be sent to an already overbooked radiology department. A solution to this situation was needed mat would: • Provide early assessment for the appropriate device; • Provide placement at the appropriate point of stay; • Provide cost savings to the hospital; and • Improve or maintain quality of care.