A PICC Team consists of nurses who are skillful in inserting, maintaining, and removing PICCs and Midlines, as well as basic lines such as PIVs. Nurses on a PICC team are usually more experienced and receive more training than nurses who place basic lines. The PICC line is more advanced than a Midline or a basic line in that it is inserted in a vein just above the elbow and ends inside the Superior Vena Cava (SVC), a vein just above the heart. As such, placement requires specialized training including the use of an ultrasound. As there are more advanced central lines than PICC lines, we refer to PICCs and Midlines as standard lines.
PICC Teams
PICC Teams can be made up of solely internal hospital staff, a combination of internal hospital staff augmented by external PICC Nurses, and solely external PICC nurses. With respect to the hybrid model, external PICC Nurses can help internal PICC Teams with coverage issues such as those that occur on weekends, holidays, and after-hours, as well as unforeseen events such as staff shortage and patient surges. By augmenting internal PICC Teams, external PICC Nurses can help reduce costs and improve patient outcomes due to their sole focus on vascular access, availability to help with coverage issues, and their typical business model of clinical case billing meaning no cost unless used. Some healthcare providers outsource all their vascular access needs to external PICC Teams that provide a range of on-call, on-demand, and on-site PICC Services, customized to the client needs. Some healthcare providers voluntarily choose this model over an internal team and other providers have no choice but to outsource. These external PICC Teams typically provide all their own medical supplies and equipment, enabling the healthcare provider to not worry about purchasing such items or maintaining any inventory. External PICC Teams serve Hospitals, LTACS, surgical centers, skilled nursing facilities, Imaging centers, Hospice, and even will go to patient’s homes to help these patients avoid transportation costs and exposure to other patients. Some of the more sophisticated external PICC Terms, which may be referred to as external Vascular Access Teams, consist of nurses that are W2 employees and certified vascular access specialists and provide administrative support that seamlessly integrates with the healthcare provider or facility. All healthcare providers should establish relationships with external PICC Teams to help provide a safety net for unknown surprises that can happen in healthcare. Some external PICC Teams enable such relationships at no cost or commitment by the client.
PICC Nurses
| PICC Vascular Access
PICC Nurses are specialists in the area of PICC Vascular Access. As with all specialized areas, some PICC Nurses have more training than others. Virtually all PICC Nurses are highly trained in the use of an Ultrasound and to provide PICC Lines, Midlines, and PIVs. Usually, the more skilled PICC Nurses place lines using needle visualization and further, are active members of the Association for Vascular Access (AVA). PICC Vascular Access may refer to the idea of obtaining Vascular Access via a PICC or, due to the informal or slang usage of the term PICC to mean vascular access, may refer simply to two separate words being used as synonyms, each referring to vascular access. Technically, it is the combination of two concepts – a PICC, a peripherally inserted central catheter line, and the general term of vascular access which can be achieved using any number of available vascular access devices. Regardless, we do not recommend the use of the term, PICC Vascular Access, as it can create confusion.
PICC Excellence
| Vascular Access Excellence
PICC Excellence is a combination of high-level expertise, experience, training, and education in the placement and maintenance of the PICC device. To achieve PICC Excellence in every PICC, PICC Nurses must examine the patient and the patient’s medical history and records, place the most clinically appropriate line for the patient, and fully document the procedure. PICC Excellence demands stringent infection control and prevention and the mitigation of potential side effects including infection and blood clots. Furthermore, PICC Excellence requires continuous training, skill verification, and improvement as clinical practices evolve over time. PICC Teams should strive and demand PICC Excellence as vascular access is critical to healthcare services. PICC Excellence also means continuing to advance healthcare and empower nurses. PICC Excellence can really be called Vascular Access Excellence. Vascular Access Excellence would expand the requirements of PICC Excellence to include greater emphasis on the entire vascular access process such as working with nursing boards, program management and administrative support, and include excellence in advanced lines including Small Bore Central Catheter Lines (such as Internal Jugular Lines, Femoral Lines, and Axillary Lines) and Large Bore Central Catheter Lines (such as Vas Caths for Dialysis and Quad Lumens). Vascular Wellness exemplifies Vascular Access Excellence.
PICC Insertion
| PICC IV
PICC Insertion generally starts in a vein just above the elbow and then threaded around the shoulder to inside the Superior Vena Cava (SVC), a vein just above the heart. The SVC is a large vein that allows caustic medications to be received and diluted before being dispersed into the bloodstream by the heart. A PICC IV may refer to the idea of obtaining IV Access via a PICC or, due to the informal or slang usage of the term PICC to mean an IV, may refer simply to two separate words being used as synonyms, each referring to an IV. Technically, a PICC is a central line IV and thus, could be called a PICC IV but generally, an IV refers many times to a Peripheral IV or PIV. As PICC is a central line, it can handle more caustic medications, enable larger fluid flow, and stay in place longer but if not needed, an IV can be adequate for infusion and other basic needs. Regardless, we do not recommend the use of the term, PICC IV, as it can create confusion. PICC Insertion is usually performed using an Ultrasound as a reliable way to guide the needle. The Modified Seldinger Technique (MST) is mostly used for correct placement and some PICC Nurses use needle guides and others use the preferred needle visualization, as this can lead to obtaining vascular access in more patients such as in difficult cases, and to achieve PICC Excellence. PICC insertion is confirmed as properly placed near the heart by either Electrocardiogram (ECG) Tip Confirmation technology or X-Ray. ECG, when clinically available, leads to faster use of the PICC, sometimes informally referred to as the PICC IV, as it removes the need to wait for the X-ray reading.
Vascular Wellness
| Vascular Access Experts
Vascular Wellness is a team of Vascular Access Experts that can provide augmentation to your PICC Team or Vascular Access Team, and can even establish, manage, and operate a vascular access department. Vascular Wellness clinicians specialize in all aspects of vascular access device (VAD) placement including assessment, insertion, maintenance, difficult placements, and possible removal. Vascular Wellness clinicians are W2 employees who complete comprehensive training that can involve placing 50 to 100 lines per procedure type, follow best practices for line placement for vein preservation and to prevent side effects, and utilize the best equipment and supplies from Bard, a leading supplier to hospitals. Vascular Wellness clinicians can place Ultrasound-Guided Basic and Extended Dwell PIVs, Midlines and PICCs, and many clinicians can place advanced devices including Small Bore Central Catheter Lines (such as Internal Jugular Lines and Femoral Lines) and Large Bore Central Catheter Lines (such as Vas Caths for Dialysis and Quad Lumens). Vascular Wellness also provides vascular access training, infection control and comprehensive administrative support including quality reports and detailed patient records for The Joint Commission surveyors. Vascular Wellness clinicians are Vascular Access Experts and would love the opportunity to help in any way needed such as by augmenting your PICC Team or Vascular Access Team.
To learn more about the benefits of outsourcing Vascular Access visit WHY OUTSOURCE VASCULAR ACCESS and Why Outsource Vascular Access? Part of the Vascular Wellness Video Series.
Vascular Wellness Serves North Carolina, South Carolina, and Virginia and expanding to Georgia, Kentucky, Ohio, Tennessee, and West Virginia.
VASCULAR ACCESS SPECIALISTS
As Vascular Access Specialists, Vascular Wellness nurse clinicians are Vascular Access Board Certified (VA-BC), insured, skill-verified, and salaried W2 employees. Vascular Wellness requires bi-annual skill verification ensuring adherence to proprietary policies, procedures, competencies, and best practices. We focus on holistic and comprehensive care and do not follow the pay per procedure model plus performance bonuses used by others that may create some adverse incentives for speed at the bedside versus holistic medical care helping to ensure the placement of the right line at the right time, the first time. In fact, Vascular Wellness employs a Director of Research and Development who not only helps us stay up to date on best practices but helps us continue to innovate and improve upon Vascular Access Services.
Vascular Access Specialists practice holistic medical care, meaning talking to the patient, addressing questions and fears, and performing a comprehensive medical review. Prior to delivering any Vascular Access procedure, the Vascular Wellness clinician reviews the patient’s medical record, including history and lab reports, and independently verifies and confirms the doctor’s order. If our clinician has questions or disagrees with the prescribing doctor, the clinician will consult with the doctor. Our Vascular Access Specialists have earned the trust of many doctors, and such doctors will defer to the clinician’s recommendation by ordering a “consult” as compared to a specific line. Patient safety and vein preservation are critical – which is why a holistic, comprehensive evaluation and Advanced Lines are significant. Other companies claiming to be Vascular Access Specialists may not follow this same approach frustrating medical doctors and nurses primarily because those 1099 Contractor PICC nurses do not place Advanced Lines (i.e, no options other than PIVs, Midlines, and PICCs) and get paid on a pay per procedure model.
In states where nurses are permitted, as Vascular Access Specialists, Vascular Wellness clinicians can provide immediate X-Ray Clearance of lines when tip confirmation is not available or appropriate and X-Ray confirmation must be used. This saves money, time, and coordination with a Radiologist or other doctor and enables the lines to be used immediately to avoid delaying treatment. Quicker therapy leads to better outcomes.
As Vascular Access Specialists, Vascular Wellness uses top rated and hospital preferred supplies from Becton Dickinson, formerly Bard (BD). Superior supplies and services help mitigate the potential for poor outcomes such as bad placement, clotting, infections, and other adverse events. Other companies that are not Vascular Access Specialists may opt for inferior supplies and older equipment.
