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How to Improve PICC Insertion Techniques


Practice makes perfect, and PICC insertion specialist know this to be quite accurate. While the majority of PICC insertions are straightforward with some training, it's the difficult ones which need experience to master.

A difficult PICC insertion may include any or all of the following

The Difficult Patient:

Typically difficult patients are encountered in neurology, psychiatry, pediatrics, elderly care and even patients in routine units making it, at times, extremely difficult to attempt any type of catheter placement. At times, it is even seen in patients who are unconsciousness or sedated who react, sometimes violently, to outside stimulus such as to pain, touch, or general care.


The Difficult Arm and/or Vein:

Sometimes even the most patient and cooperative patient has a difficult arm or vein to access. As anyone who has inserted PICC's knows, some arms are almost impossible to insert a PICC. Obesity, burns, friable veins, bleeding disorders, thrombosed veins are conditions which make placement challenging. In addition, placement of pacemakers, current or previous port placements, dialysis or mastectomy patients are situations encountered where extremity selection is hindered eliminating 50% of possible options.


Specialized Situations:

PICCs are being used more in specialized settings and situations than ever before. Therefore, as the patient population changes, it requires experience for nurses and physicians to become accustomed to the intricacies pertaining to that populace. Cases involving pediatrics, burn victims or trauma patients may, comparatively, take more time in which to become proficient due to their difficult clinical presentation.


Therefore, rather than delegating it to the "'occasional cannulator", an excellent strategy might be to employ full-time PICC nurse specialists who gather the expertise associated with PICC placement in a broader range of patient populations and underlying illnesses. In particular, with relation to the above areas of difficulty or specialization, such a professional is likely to provide excellent service and cost-effectiveness for any institution.


Such a model has been reported recently(1) from a full time vascular access nursing service (VANS). Outsourcing has many multi-disciplinary approaches such as:


  • -improving relationships with overstretched departments who are often requested to provide difficult vascular access, for example interventional radiology, anesthesia;


  • -streamlining the entire procedure of vascular access, administering therapy, monitoring, replacement, treating complications; and


  • -billing and providing ongoing training for other workers in developing their skills, particularly for the less difficult cases.


While many health care institutions and agencies appreciate and demand PICC lines insertions to benefit their patients while providing cost effectiveness, maintaining a fully trained team of professional inserters is often impossible. Outsourcing PICC lines inserting services provides benefits of fully trained professionals, ability to cannulate the most difficult cases both of which result in increased patient satisfaction and cost effectiveness by freeing other departments for other procedures.



(1) Falkowski A (2006) Improving the PICC insertion process. Nursing. Feb2006, Vol. 36 Issue 2, p26-27


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