PICC Insertion | Why to train nurses for it? | Know with SEM Trainers Blog

Why Do We Need to Train Nurses in PICC Insertion?

You can’t think of oncology care without thinking of Peripherally-Inserted Central venous Catheters (PICC). Patients who require long-term venous access, like those suffering from cancer, benefit from PICC lines. It is used to administer or deliver medication, liquid nutrition, and other treatment directly to the large central veins near the heart. If you frequently need to be jabbed for medicine or bloodwork, you may be advised a PICC line to avoid repeated irritation to your veins, and the pain from repeated jabbing.

A PICC line is a long, thin tube inserted through a vein in the arm (or, rarely, in the leg) and passed through so your doctor can access the large central veins near your heart. This is a temporary procedure, and is a great option if your treatment is going to last for at least a few days or weeks.

PICC Line Insertion: Techniques

Let’s talk about how we carry out PICC. The conventional technique is the landmark method where we feel the most prominent vein [usually] in the antecubital fossa, and cannulate it with a wide bore needle/sheath, and then insert the catheter through the sheath. Alternatively, we can use ultrasound and a micro-introducer needle where we identify [usually] the basilic vein above the elbow via ultrasound, and then insert a 21 gauge needle into the vein under direct ultrasound image. Then, we pass a guide wire through to the catheter through the needle and the sheath. This is a newer technique with a nearly 100% success rate and minimal injury rate.

Why Do We Need to Train Nurses for This?

In the past, only certified radiologists and specially-trained assistants would be allowed to perform PICC insertion. So why shift this responsibility to nurses? Well, here’s why. If we train our nurses in performing PICC insertions, it will create efficiency and take a load off an already overwhelmed hospital setting. Further, we will discuss the benefits of training nurses in PICC insertion.

Benefits of Training Nurses in PICC Insertion

As discussed previously, training nurses in PICC insertion has a number of benefits to it:

It helps nurses upskill.
With proper training, nurses can learn to competently insert a catheter, effectively avoiding running the risk of patient complications.
If nurses will be able to perform PICC insertions, it will take a considerable load off an already overwhelmed clinical setting.
It could reduce the overall costs of running the setting. When performed by a radiology specialist, a PICC insertion is more expensive.
If nurses would perform PICC insertions, patients won’t have to wait a long time for their turn. This would prevent procedure delays for the patients.
We could avoid post-insertion complications and infections alike. (PICC lines need to be monitored for complications like infections, bleeding, blood clots, nerve injury, irregular heartbeat, damage to veins, and a blocked/broken PICC line). Radiology specialists could do it, but then they likely won’t stick around after the procedure. Nurses will always be available to check up on the patient, and can keep monitoring the situation periodically. The nurses can preasses, follow-up, and troubleshoot.
It also helps avoid complications caused by delay in treatment.
Allowing nurses to handle PICC insertion ensures a better use of valuable healthcare resources.
It helps increase patient satisfaction.
It helps decrease the length of stay for the patient as delays are minimized.
It can reduce the number of failed cannulations.

Limitations

So are nurses qualified to do PICC insertions all the time? There are a few circumstances when a nurse must not insert a PICC line, and refer the patient to a medical practitioner instead:

When the patient does not give consent to the nurse.
When the patient is a minor.
When the patient has a pacemaker.
When the patient has an anatomical distortion from surgery, injury, trauma, or disease.
When the patient has bilateral arm lymphoedema.
When the patient has an implantable defibrillator.
When the patient has an arterio-venous fistula.
When the patient is on haemodialysis or peritoneal dialysis.
When the patient is scheduled for an arterio-venous fistula.
When the patient won’t allow care for the PICC line.
When the patient has an allergy to Lidocaine Hydrochloride 1%.
When the patient has a platelet count of 50 or less.
When the patient has a coagulation disorder.
When the patient has had thrombolytic therapy within 2 days.
When the patient has an inappropriate vein size under ultrasound.
When a PICC line insertion by the nurse has failed.

Nurses can be trained with a one-week course. If they have the necessary training and experience, their competence has been successfully assessed by a qualified professional, and they are confident in their ability to perform the insertions, training our nurses to perform PICC insertions would be a favourable decision.

Simulators for PICC Insertion Training

Like we said, manikins and simulators specially made for PICC insertion can help immensely with training. We provide some high-quality simulators for this purpose.

Peter PICC Line Simulator

This is a PICC line simulator and a great teaching model that is portable and lightweight. It is an upper torso with neck, chin, right arm, ribs, muscle tissue, arm skin, body skin, arm vein set, body vein set, fluid bag, a carrying case, and an additional pouch. It is anatomically correct and features the superior vena cava, subclavian, jugular, median basilic, basilic, and cephalic veins. It has a movable chin that might occlude insertion in real life just as well, and has palpable ribs that allow measuring proper catheter length from the insertion site to the second/third intercostal space. It also allows standard IV catheter placement.

Standard Arm for Chester Chest, Light Skin – VATA

This simulator helps train with infusion, withdrawal, care, securement, and dressing of multiple vascular access lines. The right chest area has a tunneled central catheter with a Dacron cuff, the external jugular vein is raised and opens to connect to a triple lumen catheter, and the upper chest area opens to connect to a subclavian catheter. It also has a real port for accessing IVAD placements. It allows infusing fluid and withdrawing blood.

We’ve been doing this for 25 years, so we know what we’re doing, and only deliver the best quality simulators. To make a purchase, you can call us at 02632 257259, +91-88495 63724, or +91-98791 03905, or write to us at sem@semtrainers.com.