According to INS position papers, a licensed physician or licensed register nurse (as determined by state regulations) who is educated and has demonstrated competency can insert a PICC. The RN must have demonstrated competency and proficiency in intravenous therapy including the insertion of short peripheral catheters and have a solid understanding of central venous catheters. Additionally, the RN should complete an educational program for PICC insertion. The educational program must include both theoretical content and clinical instruction on an anatomical model. Once the nurse has validated initial competency, there must be an ongoing continuum of competency.

PICC Training is recommended with a minimum of 8 hours to reduce your liability and promote safe practice. The term PICC qualification applies to the process of completing the Basic training then performing supervised insertions until competency is achieved. Upon completion of your supervised insertions, you are qualified to insert PICCs independently. PICC Excellence provides training for beginners and advanced inserters that includes all the required curriculum and competencies. Training options include: Group training, DVD Self Study Training, Online Self Study, or contracted on-site training. Each of these training options must be accompanied by precepted/supervised insertions at your place of employment or at another arranged location. Email or call us and we will be glad to answer questions you may have on setting up the best training program for you or your facility.

The next level for the PICC inserter would be to achieve a CPUI™ (Certified PICC/Ultrasound Inserter) designation. PICC Excellence offers a program intended to provide the vascular access clinician validation of a higher level of knowledge and practice in the field of PICC placement. PICC Certification™ is intended to be recognized throughout the healthcare community. It is a process by which an association grants recognition to an individual who has met predetermined standards specified by that association or agency. PICC Certification™ does NOT verify competency. Rather, PICC Excellence™ is certifying that the applicant has met specific standards of knowledge and training specific to PICCs as a credentialing process.

In the past, a large percentage of PICCs have been inserted in IRs. With the increasing popularity of PICCs, the high volume of PICC placements at hospitals in general, and the advent of PICC placement teams, it is time to take a closer look at the most cost effective and time efficient method of placing PICCs.

Based on a study conducted at the Department of Radiology, Dartmouth-Hitchcock Medical Center, the average cost for an RN to place a PICC bedside is $18 plus the cost of the PICC whereas the average cost for placement in IRs is $367 plus the price of the PICC. This difference may not be entirely accurate, because the costs for IR placement are carefully calculated and inclusive whereas the costs for RN placement reflect only direct personnel costs and do not include institutional and administrative overhead, support personnel, or the cost of the follow-up chest radiography. According to Santolucito, the difference is even more pronounced with bedside insertions costing $200 versus radiology department insertions at a cost of $850. Nonetheless, it is apparent that the overall cost, particularly in light of the outcome of the PICCs, is lower for placement by RNs at the bedside than it is for IRs.

With the 2004 Medicare professional reimbursement guidelines, interventionalists are no longer eager to place a PICC because reimbursement is set at $101 versus the cost of $850.

Despite the difference in cost, IR departments are essential for complicated placements, exchanges, advancements, and repositioning of PICCs. Therefore, it is reasonable and cost-effective to use a tiered approach where trained RNs place PICCS at the bedside whenever feasible relying on interventional radiology for complicated PICC placements, exchanges, advancements, and repositioning. Please refer to the references provided and consider the best options for the patient with placement of PICCs.