Table 4:

In-Hospital PICC Care and Removal

Site Insertion Model	Who Provides PICC Care	Scope of practice	Removal Authority
Site 1 ICU: Trained ICU PICC nurses Non-ICU: Interventional Radiology (IR)	IV team Registered Nurses (RNs) are responsible for all PICC care (24/7) including dressing, flushing and troubleshooting	Assess PICCs daily, monitor for infection, draw labs, perform weekly and as needed dressing changes Manage most complications, including flushing, troubleshooting and administration of tPA	ICU nurses who insert PICCs can remove if ICU patient IV team RNs can remove for non-ICU patients
Site 2 Interventional Radiology (IR) only	Bedside RNs are responsible for all PICC care	Assess PICCs each shift, monitor for infection, flush, draw labs, perform weekly and as needed dressing changes Nurses contact physician about any complications, can administer tPA with physician order	ICU nurses may remove PICCs for ICU patients Only physicians can remove PICCs for non-ICU patients
Site 3 No on-site insertion	Bedside RNs are responsible for all PICC care	Assess PICCs each shift, monitor for infection, flush, perform weekly dressing change Inconsistent reports about RNs drawing labs, some said not authorized, one said recently authorized Nurses report complications to physicians, tPA not available on site so clotted lines may just be removed	Physicians can remove, some discrepancy about whether RNs could remove PICCs General agreement about limited removal opportunity so competency concerns with both physicians and nurses Patients may be sent to another facility for removal
Site 4 Vascular Access Team (VAT)	Bedside RNs and VAT share responsibility for PICC care	Bedside RNs conduct as needed PICC care, infusions and draw labs VAT conducts daily assessment (Monday-Friday), flushes and weekly dressing change; contacted about complications, assist with troubleshooting, difficult blood draws, and administer tPA with physician order	VAT responsible for most PICC removals, physicians may remove if no team member on site or in some units (e.g., ICU) for training purposes. Some bedside nurses also trained to remove PICCs
Site 5 Vascular Access Team (VAT)	Bedside RNs and VAT share responsibility for PICC care	Bedside RNs assess for signs of infection, draw labs, perform as needed PICC care, including dressing changes and flushing VAT assess and flush PICCs each weekday and perform weekly dressing change; contacted about complications, troubleshoot and when needed can order and administer tPA	VAT responsible for most PICC removals, physicians must remove if removal is due to deep vein thrombosis Some bedside nurses also trained to remove PICCs if VAT not available at time of patient discharge

ICU = intensive care unit; IR = interventional radiology; IV = intravenous; PICC = peripherally inserted central catheter; RN = registered nurse; tPA = tissue plasminogen activator; VAT = vascular access team