To insert Peripherally Inserted Central Catheters (PICCs) using ultrasound and (in the case of PICCs) NICE endorsed new technology that confirms line tip placement in patients requiring long-term intravenous access.

The role requires autonomous practice, assessing suitability of referrals, inserting lines, following the lines up, audit of the service and teaching nurses on the wards/within the team.

The work will be mobile, occurring at patient’s bedsides and in procedure rooms about the hospital. The team will be led by a Band 7 nurse.

Duties and Responsibilities:

• Utilise clinical knowledge and advanced skills to assess suitability of referrals for central vascular access
• Communicate with the patient’s Doctor/Surgeon your decision regarding line suitability; if not suitable you can make suggestions of alternatives.  Liaise with Anaesthetic Consultant on call if another form of central access is more appropriate i.e. central vascular catheter/tunnelled line
• Be able to assess capacity for consent and gain informed consent.  If capacity is lacking liaise with the team to determine what is in the patient’s best interests 
• Insert PICC/Midlines on the wards (in the single occupancy rooms or if the patient is in a 4 bedded bay using a procedure room) using ultrasound and a sterile technique (and Sherlock 3CG in the case of PICCs to confirm tip placement)
• Administering subcutaneous local anaesthetic during line insertion to ensure patient comfort.
• If the patient is not in sinus rhythm and requires a PICC it will be necessary to organise a chest X-ray to confirm tip placement and organise review of the chest X-ray before the line can be used. 
• Document insertion and aftercare in the patients notes
• Assist with audit of number of lines inserted, locations, referring Directorates, premature line failure (including investigation and cause rectified where possible) and liaising with infection control for MSSA/MRSA rates along with auditing the number of bed days saved via prevented preventable admissions and early discharge for completion of care in the community.
• Developments in services across the Trust which are supported by this function will require the post holder to be trained and undertake additional duties as required
• To be able to assist in the management of the time of the Band 3 on the vascular access team to assist with line insertion, data collection/entry, dressing changes and bung changes on the wards. 
• To be aware of emergency procedures and always act in a way following Trust procedures, protocols and guidelines.

Health, Safety and Security

• Act in an expert way that is consistent with current legislation, trust policy and procedures for maintaining own and others safety and security
• Take a lead role in maintaining their place of work in a tidy and safe condition, thereby minimising risk to self and others
• Participate in delivering the North Bristol NHS Trusts corporate nursing agenda, taking a lead role for specific activities and projects as required.
• Identify how health, safety and security can be improved and co-ordinate action
• Adhere to infection control guidance and policy to ensure patient and staff safety

Service Improvement/Quality/Communication

• To synthesise coherently and effectively, knowledge and expertise related to the specific area of practice to provide professional leadership within the speciality and organisation
• To be proactive, expert and dynamic clinical leader, with excellent communication skills with and across professional groups
• Be involved in planning and implementing standards of care, practice guidelines and where appropriate Integrated Care Pathways, and to continually evaluate the quality of patient care
• Lead the development of nurse-led initiatives for the benefit of the client group in relevant care settings, in conjunction with the multidisciplinary team
• Demonstrate and disseminate clinical practice developments, utilising research in the specialist area of practice to develop and deliver evidence-based care.
• Be proactive in managing and facilitating change to support practice development and service improvement and modernisation activities, in accordance with local and national service policy or guidance. Contribute appropriately to clinical governance activities that relate to own area of practice and patient/client group
• Contribute to the management of the service in collaboration with the MDT and relevant care group management teams as needed, in support of the Trust and care group objectives. Ensuring cost effective use of resources, adherence to personnel policies and the achievement of service targets.
• Participate in delivering the Trust corporate nursing agenda, taking a lead role for specific activities and projects as required.

Working across professional and organisational boundaries

• Challenge professional and organisational boundaries in the interests of patients and clients and to improve health outcomes
• Develop and sustain appropriate collaborative relationships, partnerships and networks to influence and improve health outcomes and healthcare delivery systems
• To develop protocols, initiatives, documentation systems, standards, policies and clinical guidelines for others to use in practice through interpreting and synthesising complex information from a variety of sources.
• To work in collaboration with health and social care colleagues within the Trust and external primary and acute care providers to develop patient-centred pathways of care for smooth and timely referral, minimising delays and supporting shared care.

Learning and Development

• Cultivate and contribute to new ideas and innovations and to develop enhanced roles within scope of professional practice
• Act as a resource for other staff and learners on the ward and to facilitate an environment conducive to learning for all staff and learners
• Initiate and assist in evaluating the service and patient care, including patient satisfaction, using methods that are appropriate to needs and context.
• Critically appraise and synthesise the outcomes of relevant research, evaluations and audits in collaboration with colleagues to continually develop the service.
• To continue to update and reassess policies and procedures related to patient care in line with best evidence based practice.
• Identify gaps in evidence and/ or practice knowledge that require resolution through research, and initiate, undertake or assist in research activities as appropriate
• To manage, audit and monitor own workload to meet service requirements and identify future developments

Personal and People Development

• Provide education/training opportunities for nursing and other learners at pre and post qualification levels through teaching in clinical areas and lectures as necessary
• Assess training and development needs of colleagues and use appropriate strategies/opportunities to share knowledge and build on the practice of others
• Be proactive in developing and improving own knowledge, skills and attitudes in structured ways, including accessing clinical supervision and participating in Trust Individual Performance Review
• Share good practice through creating positive opportunities to network locally, regionally and nationally, and contribute to the wider development of their area of practice through publication and dissemination
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Professional

• Act in accordance with the Nursing and Midwifery Council /Health Care Professional Council Code of Conduct and the Trusts personal responsibilities framework at all times
• Contribute and participate in the clinical supervision initiative within the Trust
• Utilise personal objective settings for individuals and team members in keeping with the Trust standards
• Participate in the Trust staff appraisal, staff development and clinical updates