P ICC Line Insertion

[twoliter]

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Do any anesthesiologists yiu know insert PIC lines? Or do any residency programs you know train residents to do this? From the best I can tell, reimbursement is similar if not the same as that for central lines. I was thinking of trying to incorporate a "procedure resident" into one of our rotations. We already do the vast majority of intubations in the hospital? outside of the ED. So I wondered what the chances are the MICU would be willing to hand over their central line insertions, maybe arterial lines. That made me think maybe adding PICC access to our repertoire wouldn't be a bad idea. Can't have too much training, right?
One issue I foresee if this were to go further would be the training. Who would train us (attendings and residents). I'm sure it's not too difficult (as I've seen a few done), but here a PICC RN team does them. I could see a conflict of RNs training physicians (if they would even agree to let us take some of their business away).

What say you, great minds of the SDN?

 

[deleted126335]

Doesn't look terribly hard. I have used ultrasound to insert difficult peripheral IVs in upper arm more than once. The proverb "be careful what you wish for" comes to mind- This might become a service expectation for your department.😉

 

[ryanjmy]

I did a line clinic rotation as an intern. It was great for getting skilled with u/s. PICC lines are easy and a relitively benign procedure. Nurses did them where I trained.

I too would like to know what the reimbursement is. My hospital could use a line service. However, what little I looked into it, it looked like if you put the line in at an office you got great reimbursement, not so much at the hospital. Plus I don't think it's billed the same as a cvl were you can bill seperately for supplies and phycisian fee. I think it's a one time bundled payment.

 

[risnwb]

Learned to do them early in residency. Not difficult. Used a c arm to confirm position. We did them in the surgical ICU where the rotating residents staff the line service. It was a nice way to get lots of line experience early in residency. We did tlc's, picc lines, and Shiley Hemodialysis catheters.


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[IlDestriero]

The last thing I want is to become the line service for the hospital. There's plenty of other work already to keep everyone busy. And if it paid well, we'd probably already be doing it.
Ours are done in IR.

 

[Oggg]

I thought about starting to do these, but you also have to think about follow up issues. My IR department staff told me if we did PICCs we would have to troubleshoot our own clotted lines...

 

[Ezekiel2517]

Very simple procedure, I started doing them myself in fellowship for icu pts bc I was tired of waiting all day for the Picc team to show up. Key is positioning the arm correctly, there are good how to videos on YouTube .

 

[periopdoc]

Our PICC team is like Dominos Pizza. Placed in 30 min or less. They will place them in preop on a tough stick patient if you ask nicely. No reason for me to do them.

-bsd

 

[Triple AAA]

I never placed these lines in residency or fellowship, and I have absolutely no interest in doing them now. They are long term lines that are horrible for resuscitation. There is no reason for an anesthesiologist to learn how to do this.

 

[fakin' the funk]

I thought about starting to do these, but you also have to think about follow up issues. My IR department staff told me if we did PICCs we would have to troubleshoot our own clotted lines...

a) "Owning your procedure" i.e. dealing with its complications, longterm followup, etc, is something anesthesiologists are not good at, generally.
b) I'm sure there is a reason ($$$) that a nurse does this at most hospitals.