1. Introduction
   2. Definitions
   3. Patient Selection
   4. Anatomy
   5. Vein Selection
   6. Measurement
   7. Infection Control
   8. Access Devices
   9. The Procedure
   10. Radiology
   11. Care and Maintenance
   12. Catheter Removal
   13. Complications
   14. Documentation
   15. Legal Aspects
   16. Conclusion
   TEST
   PRINT CERTIFICATE
 
Basic PQT Manual

The above Manual is provided in a PDF format as a resource for you to use as you take this class. You will need the Adobe Acrobat Reader to view this manual. If you need the Adobe Acrobat Reader, you may download it here.
1. Introduction
 

Introduction

Peripherally Inserted Central Catheters are frequently used in acute care settings, outpatient services and many other clinical services. PICCs have become the most common central venous catheter used for the delivery of intravenous medications and solutions. In an effort to provide for the learning needs of clinicians, PICC Excellence, Inc., has developed a program of education specific to PICC and Midline catheters. The goal is to provide you with quality education and practical information applicable to your clinical setting. The Center for Disease Control Guideline for the Prevention of Intravascular Device Related Infections rates specialized education as first of their top five areas of emphasis for reducing central venous catheter infections. Various associations have indicated curriculum and competency requirements prior to PICC insertion. Groups such as the Society for Interventional Radiology (SIR), Association for Vascular and Interventional Radiology (AVIR), American Society of Radiologic Technologist (ASRT), Infusion Nurses Society (INS), Association for Vascular Access (AVA) and others provide guidelines, Standards, and recommendations for PICC training, minimum competency, and management. Medical professionals considering insertion and management of PICCs must have experience with intravenous devices and management with solid understanding of peripheral and central venous catheters prior to attempting PICC placement. Each medical professional is responsible to his licensure board to determine scope of practice issues as they apply to the insertion of PICCs. Radiological Technologists functioning without state licensure fall under the licensure of the director of radiology.

This course meets and exceeds required curriculum for PICC and Midline insertion training. Didactic information included in this manual is followed by a practicum with supervised insertions to establish competency. Competency should be assessed over at least 2-5 supervised insertions using standard criteria for assessment such as the competencies included at the end of this manual. Supervised insertions are designed to establish patient safety and a level of comfort for the inserter as well as the supervisor, each knowing that competency in the insertion procedure has been achieved. PICC insertion is considered an advanced level of practice requiring a higher level of knowledge and expertise, only performed by those who have reached the level of specialists specifically trained for the procedure. A supervisor for PICC insertion observation is qualified through licensure, as with a Medical Doctor or Registered Nurse, and through demonstrated PICC experience of more than 8 insertions. The purpose of a PICC supervisor is to spot sterile technique, manage any complications that may arise, help the inserter to learn from their experiences and, if possible, allow the insertion to be successful if difficulties arise. Education and competency are necessary prior to independent PICC insertion. Overall medical liability is reduced with proof of education and competency for a specific procedure.

Objectives

  • Demonstrate understanding of the definition of a Peripherally Inserted Central Catheter by acknowledging the Intravenous Nurses Standards of Practice and the National Association of Vascular Access Network’s (NAVAN now AVA) designation for terminal tip location
  • List the indications for use of PICC versus Midline
  • Identify indications for the use of the Modified Seldinger insertion procedure
  • State the differences between the traditional versus the Modified Seldinger Techniques (MST)
  • List two benefits associated with the use of MST.
  • Differentiate PICC line products used for the Seldinger insertion procedure
  • List the procedure used for PICC placement with MST
  • Describe flushing and dressing changes necessary for PICCs