Advisory Ruling Number: 9301
The Massachusetts Board of Registration in Nursing issues this Advisory Ruling on Nursing practice pursuant to Massachusetts General Laws, chapter 30A, section 8 and chapter 112, section 80B.
Date Issued: January 29, 1993
Date Revised: July 10, 2002; July 13, 2011
Scope of Practice: Registered Nurse
To guide the practice of the Registered Nurse whose clinical responsibilities include the insertion, management, and withdrawal of a Peripherally Inserted Central Catheter (PICC).
A PICC is a long intravenous access device inserted into one of the superficial veins of the peripheral vascular system and advanced until the tip rests within the superior vena cava (SVC) near its junction with the right atrium or, if placed via the femoral vein, the tip dwells in the inferior vena cava (IVC) above the level of the diaphragm.
Such practice must be in compliance with: 244 CMR 3.02: Responsibilities and Functions - Registered Nurse; 244 CMR 9.03(5): Adherence to Standards of Nursing Practice; 244 CMR 9.03(9): Responsibility and Accountability; 244 CMR 9.03 (10) Acts within the Scope of Practice; 244 CMR 9.03 (11)Performance of Techniques and Procedures; 244 CMR 9.03 (12) Competency; 244 CMR 9.03 (14): Asepsis and Infection Control; 244 CMR 9.03(38) Administration of Drugs; 244 CMR 9.03(44) Documentation; 244 CMR 9.03(46): Responsibilities of Nurse in Management Role
Advisory: The registered nurse licensed by the Board will engage in the practice of infusion nursing in accordance with accepted professional standards.**
Further, it is the Board's position that these standards, in the context of the care of the patient requiring PICC insertion, maintenance, or withdrawal recognize the nurse as responsible and accountable for:
- Verifying that orders are written by a duly authorized prescriber;
- Completion of a theoretical and practical formal educational program and possessing the knowledge, skills and abilities to perform the activity safely, effectively and competently including, but not limited to, advanced knowledge in:
- Patient assessment/screening;
- Safe equipment use;
- Insertion/withdrawal techniques;
- PICC management strategies;
- Ability to anticipate and recognize potential complications; and
- Ability to recognize and appropriately react to emergency situations.
- Documentation of initial and continued competency.
- Recognizing it is not within the scope of practice for a Registered Nurse to operate fluoroscopy or radiographic equipment.
PICC techniques for placement of PICC lines may include, but not be limited to, any Seldinger technique, suturing the line for stabilization, use of real-time visualization techniques such as ultrasound and fluoroscopy, use of adjunct devices, and assessment of a chest radiograph to determine PICC tip placement must have the following additional documented evidence of clinical competency prior to employing these activities:
- Completion of a formal education program which includes a theoretical and practical component for each specific activity.
- For inclusion of the activity of assessing a chest radiograph to determine PICC tip placement, completion of a formal education program which includes appropriate theoretical and practical component. The education program must have oversight from the organization's department of radiology. It is not within the scope of Registered Nurse practice to interpret the chest radiograph, provide a comprehensive radiographic report or to make a medical diagnosis.
The nurse in a management role must ensure that there are organizational policies that include, but are not limited to:
- Protocols for assessing and documenting the advanced education and validation for RN initial and continued competency for each activity;
- Protocols for provision of clear, complete and culturally appropriate informed consent;
- Nursing care responsibilities, including, but not limited to patient assessment, monitoring, medication administration, potential complications, and documentation criteria;
- Emergency protocols including, but not limited to, immediate, on site availability of emergency equipment, medications and personnel;
- When placing PICC with fluoroscopy guidance, organizational policies and procedures must account for radiation protection and personnel who will operate the fluoroscopy equipment, pursuant to appropriate statute and regulation. It is not within the scope of practice for a Registered Nurse to operate fluoroscopy or radiographic equipment; and
- The resources necessary to provide safe implementation of these procedures.
** Professional Standards and references include, but are not limited to the following:
- Infusion Nursing Standards of Practice, (Journal of Infusion Nursing, Infusion Nurses Society)
- Policies and Procedures for Infusion Nursing 4 th Edition, (Infusion Nurses Society)
- Association for Vascular Access
This information is provided by the Division of Health Professions Licensure within the Department of Public Health.