Abstract

The Minnesota Department of Health Ionizing Radiation Rules “prohibits the use of fluoroscopy by a person other than a licensed practitioner of the healing arts... when the licensed practitioner of the healing arts is not physically present in the room” (Minnesota Administrative Rules, 2007). Getting a licensed practitioner into the room caused delays in completing PICC line insertion procedures. To minimize these delays we considered multiple options; one of the options was to have PICC nurses licensed to operate the fluoroscopy machine. This article will explain the process the Vascular Access Department at the University of Minnesota Medical Center, Fairview went through to make this option a reality.

Our team has demonstrated that with proper training, education, machine maintenance and completion of competencies, nurses can operate fluoroscopy independently and clear PICC lines for use with a high degree of safety, efficiency and accuracy.

Abstract

Traditionally, nurses placing peripherally inserted central catheters, (PICCs) must obtain radiological clearance before utilizing the catheter. At West Virginia University Hospitals, this clearance is performed by a radiologist. The PICC team at WVUH felt strongly that this process could be expedited if they were able to interpret the PICC placements themselves. They took a proactive approach and attended specialized training in the radiological interpretation of PICC tips. They then utilized the West Virginia State Board of Examiners for Registered Nurses decision making algorithm to determine that this practice would be within their scope of practice. The team chose to conduct a retrospective study of cross-sectional data to determine if their radiological interpretations were as accurate as the radiologists. A two-tailed t-test was done to determine if they could clear the PICCs in a more timely fashion than awaiting clearance from the radiologists. The premise of reviewing this data was to ensure that their accuracy and timeliness would have a positive impact on patient care delivery.