We have identified a core group of 7 nurses for training on PICC removal. Is this enough? Should we train other nurses? What is the number of removal procedures required to maintain competency with this task?
I have just been through the published literature on competency assessment. I know nurses want to be told a "magic number" of procedures that will ensure they remain competent, however that number is just not known for any procedure. I have not found any recommendations on a specific number of times that a procedure should be performed to be considered "competent".
Also, I can not determine if this small group of only 7 nurses will meet the needs of your hospital. That will depend on numerous variables such as how many patients you have, how many PICCs are inserted and removed at your facility, where those nurses will be working and where the patient in need of a PICC removal will be located, plus numerous other issues.
Each hospital must make the decision about the number of supervised procedures required for initial competency with 3 to 5 being the most common. On going competency is determined by outcomes. So you should have a mechanism for tracking what happens to these catheters. How many are discharged with the PICC in place, with removal to be done by home care? How many are removed when there is no longer a clinical need for it such as end of therapy? How many are removed for a complication? Who is assessing for those complications? Who is managing those complications? Who is working to prevent those complications?
While this approach may work for your hospital, it is not one that I have much confidence in working very well. It forces the nurse into a task-oriented technical role. It ignores the other issues that will arise during the life of that PICC. Insertion requires less than 1 hour, but what happens to that catheter during the days, weeks, months or years of its use will have the most impact on the outcome for the patient. This is why the services of infusion nurse specialist are needed.
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