RN vs. MD Interpretation of PICC Tip Placement
At West Virginia University Hospital (WVUH) a team of nurses is responsible for placing peripherally inserted central catheters (PICCs). The WVUH PICC team places approximately 200 PICCs per month and noticed a lag time between placement and clearance of the PICC. The standard of care for PICCs is for a nurse to place the PICC and wait for clearance for use from a radiologist. Since radiologists are responsible for films hospital-wide, the clearance step was slowing down the process. To take the first step towards solving the issue, the PICC team at WVUH enrolled in a PICC tip interpretation class. After the educational step, a study was conducted to determine if the PICC team interpreting tip placement was faster than and as accurate as waiting for a radiologist.
The study included all adult PICC placements between April 10, 2008 and July 10, 2008. Any patient with incomplete documentation was removed from the sample. The interpretation time was compared for MDs and RNs. The study determined that MDs take longer to interpret the X-rays than RNs. Agreement on X-ray interpretation was also studied. It was determined that RNs and MDs will agree on interpretation of X-rays between 93.8% and 97.8% of the time.
Based on the results of the study, the policies at WVUH will be rewritten to allow nurses to give radiological clearance of PICCs. In addition, PICC team members will complete yearly competency updates along with radiology department physicians to maintain proficiency. PICC patients will benefit by not having to wait as long for radiologist clearance to start IV therapy.
To read the abstract of the study or to purchase a copy of the full study, click here.
Photo Credit: Interplast