Can RNs Remove Peripherally Inserted Central Catheters (PICCs)?

Carolyn Buppert, MSN, JD

Disclosures

August 04, 2016

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Question

Should RNs be able to remove PICCs with a written order to do so, and is any special education or preparation required?

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

A registered nurse (RN) working in a skilled nursing facility writes:

We (the RNs) are given orders to remove patients' peripherally inserted central catheters (PICCs). I thought that removing a central line was an advanced practice skill. Can I refuse to remove a patient's PICC because I'm not an advanced practice nurse?

You shouldn't assume that PICC line removal is or isn't an RN function without checking with your state Board of Nursing. Some state boards have addressed PICC lines in their policies and others have not. Often, the statutes that describe the scope of practice for an RN have rather broad language, such as this language from the Florida Nurse Practice Act[1]:

'Practice of professional nursing' means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to:

  1. The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others.

  2. The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments.

  3. The supervision and teaching of other personnel in the theory and performance of any of the above acts.

Given the broad language of the statutes, boards often will address specific questions in policy statements. These statements are not "laws," but they come close, and nevertheless they provide valuable guidance on what the board thinks about an issue and how the board would rule if a nurse were reported for a scope-of-practice problem.

Some boards of nursing have provided published direction for facilities and nurses on insertion and removal of PICC lines. The questions to answer are:

  1. Does the board of nursing have any policy on RNs removing PICC lines? If so, you and the facility need to follow the policy.

  2. Does the facility have a policy on PICC line removal? Does the policy call for training and initial supervision of nurses before the nurse may remove lines unsupervised?

  3. Have you completed appropriate training on how to remove the line and what to do afterwards to ensure that the tip has been removed and is uninfected?

  4. Do you feel appropriately prepared to remove a PICC line and provide any follow-up that is necessary?

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