I am starting off our blog with this topic because we often get the question- After I take a class, am I then PICC certified? or What is involved in becoming PICC certified? I have always tried to be careful to not loosely use the words “PICC certification” and instead used words to describe meeting competency criteria for independence in PICC insertion and care. The problem primarily is with the use of the word “certification”. On their website the American Board of Nursing Specialties (ABNS) defines certification as ”the formal recognition of the specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes”. Nurses that insert and care for PICC line catheters as a primary part of their job may opt to specialize in infusion nursing, but the performance of PICC insertion and care procedures does not qualify as a separate nursing specialty. In spite of this fact, establishing and obtaining competence in PICC insertions is commonly referred to within health care as obtaining ”PICC Certification” or becoming “PICC certified”. Therefore many clinicians looking to obtain training in PICC insertion and care procedures often search for PICC certification programs. The words ”PICC certification” do not have a standard definition; i.e. there is no non-profit third party organization that is dedicated to defining and establishing standards for PICC certification. In health care, there are other skills that have non-profit organizations that establish the criteria for certification. CPR certification overseen by either the American Heart Association or the Red Cross is an example of this. But since there is no organization like this in existence for PICC certification, the establishment of criteria for credentialing clinicians in PICC certification is done by organizations involved in training clinicians in PICC care and insertion procedures. This includes health-care facilities and continuing education companies. Program content and requirements can vary widely.
With such a wide variety of programs available, how do you choose a PICC education program to best suit your needs? Fortunately, state guidelines and organizations such as the Infusion Nurses Society (INS) exist. The INS is a non-profit organization established in 1973 to ensure high quality in infusion therapy for patients and to establish standards and guidelines to be followed by nurses involved in the specialty practice of infusion therapy care and procedures. The INS has published standards of practice position papers that require clinicians to possess and demonstrate specific and comprehensive knowledge related to PICC insertion and care. Another important organization is the Association of Vascular Access (AVA), AVA is a multidisciplinary organization composed of clinicians, educators, regulators and manufacturers from the medical field of Vascular Access. Part of AVA’s published mission is to improve patient safety, comfort and outcomes; and optimize professionals’ knowledge and skills in vascular access. The best programs will have their education and clinical assessment criteria founded on the basis of standards, guidelines, and recommendations set by government and leading industry organizations such as the INS and AVA and organizations like the Center for Disease Control (CDC), the Joint Commission (JCHAO), and the Institute for Healthcare Improvement (IHI).
Unfortunately, the expectation that one can be certified in PICC insertion simply by taking a one day class is encouraged by companies that advertise certification granted solely after taking their one day, 8 hour or so PICC training class. Is that true, and possible? Not likely. The more likely scenario is that the ad leaves out the clinical precepting requirement. Or it is possible that the ad is correct and all that is required for PICC ”certification” by such a company is an 8 hour class room only experience with maybe a few insertions on class mates. I have to ask myself would I want a clinician finishing such a program inserting a PICC line in me or one of my family members? My answer?… Uhm, no.
A reputable company that provides continuing education in infusion related procedures stays current with industry practices and established guidelines and passes on applicable information to their trainees. The INS has published a position paper on PICCs in which the qualifications for insertion section states that the INS supports that a licensed physician or registered nurse that is educated and has demonstrated competency can insert a PICC. Regarding RNs, the position paper goes on to state: “The RN must have demonstrated competency and proficiency in intravenous therapy, including the insertion of short peripheral catheters, and a solid understanding of central venous catheters. Additionally, the RN should complete an educational program for PICC insertion. The education program must include both theoretical content and clinical instruction on an anatomical model. Once the nurse has validated initial competency, there must be an ongoing continuum of competency. An organization or facility must establish a program for maintaining clinical competency for device insertion within its chosen framework. Ongoing competency validation includes the knowledge and ability to perform the insertion safely and knowledge of appropriate care and maintenance strategies. All facilities involved with insertion of PICCs should have formal organizational policies and procedures in place that provide clear lines of responsibility for insertion, care, and maintenance. Finally, qualifications for inserting PICC lines must be consistent with state and federal laws.” Potential trainees should be aware of the PICC line procedure criteria that govern their practice in their state of residence. For example in Connecticut (our state of primary operations); the Board of Examiners for Nursing has published specific guidelines that spell out requirements for registered nurses inserting and removing specialty lines like PICC line catheters. These guidelines are very similar to the INS PICC position paper regarding qualifications for insertion and in addition the Connecticut guidelines include a requirement that a nurse must possess “substantial knowledge and experience in intravenous therapy” (click here to view a copy of these guidelines). To meet established industry criteria for PICC insertion and care the completion of a period of supervised clinical experience following a PICC insertion education class is a necessity. In addition to the technical skills, PICC insertion and care requires patient assessment and critical thinking skills that include the ability to judge when to change course in the procedure.
How do clinicians obtain PICC certification after completion of a PICC Resource class? There are two ways to complete training and become certified after a class, the traditional way through the clinician’s employing facility, or through our PICC insertion and care certification program. The traditional option is the way most clinicians have completed their training and become independent in PICC insertion and care procedures. This involves becoming credentialed by the employing facility after meeting their established policy and competency requirements that includes completion of a supervised clinical component. The other way is after completing clinical precepting- the clinician can apply for PICC certification through us. This involves documentation of the precepted and independent insertions, supervisor or other approved clinician recommendation, and successful completion of our PICC line certification exam. Does certifying either of these ways confer a national certification? Individual facility conferred certification is considered an “in-house” type certification that may not be recognized if a clinician leaves to practice at an outside facility. In actual practice as long as the PICC education class taken was administered by a national company and the clinician can produce proof of competency with an accepted number of supervised and independent clinical insertions; it is likely that the new facility will accept the certification. Regarding PICC Resource Associates, LLC programs– we are a national organization in that we offer continuing education programs that are accepted throughout the U.S. Our program contact hours are offered through an American Nurses Credentialing Center (ANCC) approver and they are valid nationally.