Building a Better Health Service

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Nurse led PICC line insertion

Development of a Nurse Led PICC Line Insertion Service for Haematology and Oncology Patients, University Hospital Waterford Hospital

This project involved the development of a nurse-led peripherally inserted central catheters (PICC) line insertion service for haematology and oncology patients using 3CG technology.

Prior to this, PICC lines were typically inserted by a consultant interventional radiologist.


How it works

An analysis and bench marking of the pre-existing PICC line insertion service was completed. The project team then developed a comprehensive business case to support the development of a nurse-led PICC line insertion service. This was approved by the Medical Directorate Leadership Team and Executive Management Board and governance arrangements were put in place.

Protocols, referral pathways, patient pathways, data collection tools and audit process agreed. A standard operational procedure was developed.

Two oncology clinical nurse specialists (CNS's) and one haemotology clinical nurse specialist completed a training programme and competency assessment.

A pathway was developed with the community intervention team to carry out PICC line flushes in the patients home. These occur within 24 hours post line insertion.

Following this, a weekly PICC line insertion clinic commenced.

The team

A nurse led PICC line service was developed. Three clinical nurse specialists were trained to autonomously insert PICC lines using 3CG technology.

Impact of the project

To date, 29 PICC lines have been inserted by the CNS's.

The patient no longer has to wait for extended periods of time to have a PICC line inserted. This greatly decreases the anxiety patients experience while they are waiting to begin chemotherapy treatment. Other impacts include:

  • patients also spend less time in hospital by not being addintted to a surgical day ward
  • wait times for insertion of PICC lines were reduced
  • patients commenced cancer treatment in a timely manner

Total savings were estimated to be €47, 860.

A database has been developed to gather all the relevant evidence which will allow for a full audit after 12 months.