Stanford Picc Class Feb 13th 2007

CLASS REQUEST FORMPlease complete this form and email it to [email protected]. Allow three weeks for processing.

Complete this form in its entirety for processing. Incomplete forms slow the processing time.This shaded area is for office use only

Class Number Time: Today's Date:

TM: Mayor Type of Activity:

Territory #: 855

Date of activity: Feb 13th, 2007

Instructor: Nadine Nakazawa, RN

# of Participants: 15

Registration Fee: $150.00 All piccs / power too

Different Charge TM Address: 1535 Vista Club Cr, #205City, State, Zip: Santa Clara, CA 95054

Free Participants: TM Extension:

Account Info: Shipping Info:(select one option)

Attention

HUSI/SHAD#: Facility

Address

City, ST, Zip

Facility Information Contact InformationName: Stanford Center for Education Name: Nadine Nakazawa

Address: 1451 S. California Av Title: Picc nurseCity, State Zipcode: Palo Alto, CA Depart.:

Phone:Fax:

Other:

Do you want a flyer:

Products Requested: Please type the product code(s) of the needed kits1 Full Groshong 3 52 Full power picc 4 6

You will need:

Would you like to have the new Educational Brochure sent to the Class?

Additional InformationPlease fill out this portion as necessary

Flyer Information: Indicate any particular information that you would like incorporated in the flyer for this activity (i.e.: directions,special instructions, room number, etc.)

Any additional Information: This is not a standard Picc class it is an educaiton and re-training class with A.A. for the morning group at Toledo Hospital7 ea full power picc, 5 fr single is fine, 7 ea. full Groshong tray.

To print flyer for class, please click on the

button which applies to you.

New

Existing

Competitive

Ship to TM

Ship to the activity location

Ship to alternate location - indicate below

Yes No

One kit per participant One kit per every two participant

Yes No

Basic GroshongBasic Per-Q-CathNeonatal GroshongNeonatal Per-Q-CathAdvanced Full DayAdvanced Half DayInservice-SafetyPrecepting - SiteRite - MicrosMiscellanous

Full Flyer

Advanced Flyer

Basic Flyer

A21

If applicable: please indicate if there will be a different charge for some of the attendees.

A23

If applicable: please indicate how many participants will attend the activity for free.

Justification FormEducational Opportunities - Product Sales Growth Tracking form

Please note that this portion is mandatory for the completion of any educational activity.

Customer ID#:

Product Number Current Monthly Anticipated Actual Sales Actual Sales GrowthActual Sales Monthly Growth % 3 months after 6 months after during measurement

Educational Activity Educational Activity period %Units Dollars Percentage Units Dollars Units Dollars Percentage

The growth measured here may be accounted for by the educational opportunity, or may be only a small portion of many factorsthat influenced growth during the time period measured. Please take a few minutes to explain why this educational activity is

important to you and your account. Your comments will be used when making decisions about future educational opportunities.

Any participants from other facilities at this educational activity?

How will this educational activity affect their facility? Retrain additional nurses for Picc team

Yes No

Cost Tracking Form for Basic Groshong Classes

TM: Number of Participants:Date of Class: Registration Fee:

Instructor: Different Fee:

Sec A) Item and Description: Quantity Required Price Total(enter values here)

Basic Workbook $15.00 $0.00$35.12 $0.00$23.51 $0.00$53.20 $0.00$33.74 $0.00$22.25 $0.00$51.96 $0.00$68.06 $0.00$46.76 $0.00$78.78 $0.00$78.75 $0.00$46.76 $0.00$46.76 $0.00$61.64 $0.00$61.64 $0.00

$103.75 $0.00$13.27 $0.00$13.18 $0.00$12.68 $0.00$14.08 $0.00$13.65 $0.00$1.54 $0.00

$0.00

Sec B) Consultant Expenses:(enter values here)

Consultant Fee: $0.00Consultant Airfare: $0.00Consultant Meals: $0.00Consultant Mileage (.36 cents) $0.00Consultant Transportation: $0.00Consultant Lodging: $0.00Consultant General Expenses: $0.00

$0.00

Sec C) TM Expenses:(enter values here)

Meals for Workshop: $0.00Miscellaneous Expenses: $0.00

$0.00

Total Expenses of Workshop (Sec A + Sec B + Sec C) $ -

Income from Workshop $ 2,250.00

Total cost/income of Workshop $ 2,250.00

7717300 3Fr Intermediate7717305 3Fr Basic 7717307 3Fr Full 7717400 4Fr Intermediate7717405 4Fr Basic 7717407 4Fr Full 7927500 NXT 5Fr Intermediate DL 7927505 NXT 5Fr Basic DL 55 cm 7827507 NXT 5Fr Full DL 45 cm7927507 NXT 5Fr Full DL 55cm 7927505 NXT 5Fr Basic DL 7827505 NXT 5Fr Basic DL 45 cm7927505 NXT 5Fr Basic DL 55 cm7857505 NXT 5Fr Basic DL 45cm7827508 NXT 5Fr Full DL 45 cm0668935 3.5Fr Microintroducer0668945 4.5Fr Microintroducer0668950 5Fr Microintroducer0668960 6Fr Microintroducer0668970 7Fr Microintroducer7725520 Statlock Device

Cost Tracking Form for Basic Per-Q-Cath Classes

TM: Mayor Number of Participants: 16Date of Class: Feb 13th, 2007 Registration Fee: $150.00

Instructor: Nadine Nakazawa, RN Different Fee: $0.00


Basic Workbook $15.00 $0.00$23.86 $0.00$28.61 $0.00$72.15 $0.00$27.70 $0.00$71.25 $0.00$28.68 $0.00$73.43 $0.00$73.76 $0.00$13.27 $0.00$13.18 $0.00$12.68 $0.00$14.08 $0.00$13.65 $0.00$1.54 $0.00

$0.00


Consultant Fee: $0.00Consultant Airfare: $0.00Consultant Meals: $0.00Consultant Mileage (.36 cents) $0.00Consultant Transportation: $0.00Consultant Lodging: $0.00Consultant General Expenses: $0.00

$0.00


Meals for Workshop: $0.00Miscellanous Expenses: $0.00

$0.00

Total Expenses of Workshop (Sec A + Sec B + Sec C) $0.00

Income from Workshop $2,250.00

Total cost/income of Workshop $2,250.00

4132000 2Fr Intermediate Tray4133110 3Fr Intermediate Tray4133117 3Fr Full Tray4134110 4Fr Intermediate Tray4134117 4Fr Full Tray4135110 5Fr Intermediate Tray4135117 5Fr Full Tray4236117 6Fr Full Tray DL0668935 3.5Fr Microintroducer0668945 4.5Fr Microintroducer0668950 5Fr Microintroducer0668960 6Fr Microintroducer0668970 7Fr Microintroducer7725520 Statlock Device

Cost Tracking Form for Advanced Classes

TM: Mayor Number of Participants: 16Date of Class: Feb 13th, 2007 Registration Fee: $150.00



Advanced Workbook $25.00 $0.00$28.61 $0.00$27.70 $0.00$28.68 $0.00$53.20 $0.00$51.96 $0.00$78.78 $0.00$78.75 $0.00

$103.75 $0.00$35.12 $0.00$33.74 $0.00$68.06 $0.00$68.06 $0.00$13.27 $0.00$13.18 $0.00$12.68 $0.00$14.08 $0.00$13.65 $0.00$40.50 $0.00$40.50 $0.00$40.73 $0.00

$0.00


Consultant Fee: $0.00Conultant Airfare: $0.00Consultant Meals: $0.00Consultant Mileage (.36 cents) $0.00Consultant Transportation: $0.00Consultant Lodging: $0.00Consultant General Expenses: $0.00

$0.00


Meals for Workshop: $0.00Miscellaneous Expenses: $0.00

$0.00

Total Expenses of Workshop (Sec A + Sec B + Sec C) $0.00

Income from Workshop $2,250.00

Total cost/income of Workshop $2,250.00

4133110 3fr PQC Intermediate4134110 4fr PQC Intermediate4135110 5fr PQC Intermediate7717307 3Fr Gr Full 7717407 4Fr Gr Full 7827507 5Fr NXT Full DL 45 cm7927507 5Fr NXT Full DL 55cm 7827508 5Fr NXT Full DL 45 cm7717300 3Fr Gr Intermediate7717400 4Fr Gr Intermediate7827500 5Fr NXT Inter. DL 45 cm7927500 5Fr NXT Inter. DL 55 cm 0668935 3.5fr PTFE Microintroducer0669845 4.5fr PTFE Microintroducer0668950 5fr PTFE Microintroducer0668960 6fr PTFE Microintroducer0668970 7fr PTFE Microintroducer9001C0212 18ga Needle Guide9001C0214 20ga Needle Guide900013B01 21ga Needle Guide

Cost Tracking Form for Safety Inservice

TM: Mayor Number of Participants: 16Date of Inservice: Feb 13th, 2007 Registration Fee: $150.00



$8.55 $0.00$8.55 $0.00$8.54 $0.00$9.12 $0.00

$0.00


Consultant Fee: $0.00(Consultant Fee for Satefy Ins.

will be from $25 to $50/hour aspre-arrenged by you and yourinstructor)Consultant Mileage (.36 cents) $0.00Consultant General Expenses: $0.00

$0.00

Total Expenses of Inservice (Sec A + Sec B) $0.00

Income from Inservice $2,250.00

Total cost/income of Inservice $2,250.00

4133117 3Fr Safety Excalibur4134117 4Fr Safety Excalibur4135117 5Fr Safety Excalibur4236110 6Fr Safety Excalibur

Registration

Name:

Full RegistrationAddress:

City:

State:

Zip Code:

Daytime Phone ( ) -

Professional License #:

Employer:

Fee Enclosed:

Program Approval

Discount fee by 20% if you belong to UNA, include a copy of your UNA Membership Card

insufficient registration.

This program is approved by the Utah Nurses Association as an approver of the Continuing Education for nursing by

the American Nurses Credentialing Center Commission on Accreditation. This

course has been approved for 9.9 contact hours.

“Vascular Access New Technology for Advanced

Practice ”A Nine Hour Interactive Workshop

Awarding 9.9 CEU Credits

A workshop designed for the experienced vascular access clinician who wants to implement advanced insertion

techniques.

Please mail fee & registration to:

Bard Access SystemsSteve Sigl

521 Columbia Cr DrSan Ramon, CA. 94582

Workshop Information About the Instructor

Date: Feb 13th, 2007

Time:

TM: Mayor

Location: Stanford Center for Education

1451 S. California Av

Palo Alto, CA

Fee: $150.00

Program Schedule Refund Policy7:30-7:45 am Registration

7:45-8:00 am Welcome/Introduction

8:00-8:15 am

8:15-9:15 am

9:15-9:30 am

9:30-9:45 am Break Target Audience9:45-10:15 am Case Studies

10:15-11:00 am

11:00-11:15 am

11:15-11:45 am The Program

11:45-1:00 pm Lunch

1:00-1:30 noon

1:30-1:45 pm

1:45-2:15 pm Completion Requirements

2:15-3:00 pm Break

3:00-3:15 pm Ultrasound Basics

3:15-3:30 pm Capital Equipment CostJustification 1. Attends the ENTIRE workshop3:30-4:00 pm Site~Rite Ultrasound Use and Tips 2. Completes the practicum4:00-4:15 pm 3. Returns a completed course evaluation form

4. Pays appropriate fees4:15-5:45 pm Practicum

5:45-6:00 pm Course Evaluation

The participant will be able to demonstrate MicroIntroducer insertion technique competence on an anatomical model in a laboratory skills practicum

Nadine Nakazawa, RN, CRNI has been a picc nurse at Stanford University Medical center for

over 15 year. She has been a picc instructor for over 10 years and has been on the foreftont of

many picc development innovations.

Limited class size and open discussion facilitated by the instructor promotes continuous interaction between faculty and participants. Participants should dress comfortably, relax and enjoy this unique learning

experience.

NOTE: The workshop begins promptly at 7:45 am. Late arrivals may attend the remainder of the workshop but will NOT receive a certificate of

completion.

This program meets the following objectives:

The student will be able to define an early vascular access assessment program. Tuition will be refunded (less a $10.00 processing fee) if

notification is received no later than 7 days prior to the workshop. Notification may be verbal or in writing. Participants may also

elect to send another person in their place.

The student will be able to articulate an understanding of reactive versus proactive IV therapy.

Defining a Vascular Access Early Assessment Program

The student will be able to review case studies and determine the correct vascular access device based on DRG, LOS, or drug therapy.

Reactive Versus Proactive IV TherapyVAD Selection by Diagnosis/LOS/Drug Therapy

The student will be able to articulate an understanding of ultrasound basics.

Appropriate participants include those who have previously attended and successfully completed a thorough basic PICC

workshop followed by extensive clinical experience in the insertion, use and maintenance of these devices.

The student will be able to articulate the basic functions of a portable ultrasound unit.

Implementation of the Assessment Advantage Program

The student will be able to articulate the steps used when incorporating portable ultrasound for inserting a PICC.

Advantages/Disadvantages of the MicroIntroducer insertion technique

The participant will be able to demonstrate portable ultrasound competence on an anatomical model in a laboratory skills practicum.

Troubleshooting the MicroIntroducer Insertion Technique

The program instructors bring to you their experiences of hundreds of PICC/Midline insertions along with the vast

experience of Bard Access Systems, which encompasses thousands of catheter placements throughout the world.The student will be able to define advantages of using the

MicroIntroducer technique for gaining peripheral venous access.Potential Complication Management

MicroIntroducer insertion cost Justification

The student will be able to list disadvantages of using the MicroIntroducer technique for gaining peripheral venous access.

MicroIntroducer Insertion Technique Demonstration

Certificates of completion will be issued at the end of the workshop providing the participant has met the following

requirements.The student will be able to demonstrate techniques for overcoming difficulties during use of the MicroIntroducer insertion technique.

The student will be able to articulate the potential complications associated with the MicroIntroducer insertion technique along with the nursing interventions for each potential complication.

Vascular Access with Site~Rite Ultrasound System

Advanced Half-day Registration

Advanced Half-day RegistrationName:

Address:

City:

State:

Zip Code:

Daytime Phone ( ) -


Employer:

Fee Enclosed:

Please mail fee & registration to:

Bard Access SystemsMayor

1535 Vista Club Cr, #205Santa Clara, CA 95054

Program Approval

Discount fee by 20% if you belong to UNA, include a copy of your UNA Membership Card

We reserve the right to cancel the workshop due to insufficient registration.

This program is approved by the Utah Nurses Association as an approver of the Continuing

Education for nursing by the American Nurses Credentialing Center Commission on Accreditation.

This course has been approved for 3.3 contact hours per section.

A workshop designed for the experienced vascular access clinician who wants to begin using the MicroIntroduction

insertion technique.

PICC and Midline Catheter Vascular Access Using The

MicroIntroducer Technique

Half-day Workshop Information

Feb 13th, 2007 Program Schedule About the Instructor

Stanford Center for Education 7:30-8:00 am Registration

0

1451 S. California Av 8:00-8:05 am Welcome/Introduction

Palo Alto, CA 8:05-8:15 am

8:15-8:45 am

Fee $100.008:45-9:15 am Potential Complication Management

9:15-9:30 am Cost Justification

9:30-10:00 am

TM 10:00-10:45 am Practicum

1-800-443-3398 ext. 0000 10:45-11:00 am Course Evaluation Refund Pollicy

Target Audience

The Program

Completion Requirements

1. Attends the ENTIRE workshop2. Completes the practicum3. Returns a completed course evaluation form

Advantages/Disadvantages of the MicroIntroducer Insertion Technique

Troubleshooting the MicroIntroducer Insertion Technique

For further information on this offering please call: MicroIntroducer Insertion Technique

Demonstration

Tuition will be refunded (less a $10.00 processing fee) if notification is received no later than 7 days prior to the workshop. Notification may be

verbal or in writing. Participants may also elect to send another person in their place.


NOTE: The workshop begins promptly at 8:00 am. Late arrivals may attend the remainder of the workshop but will NOT receive a certificate

of completion.

The student will be able to list five factors that may negatively influence their ability to obtain peripheral venous access in the standard fashion.

The student will be able to define advantages of using the MicroIntroducer technique for gaining peripheral venous access.

The student will be able to list disadvantages of using the MicroIntroducer technique for gaining peripheral venous access.

Appropriate participants include those who have previously attended and successfully completed a thorough basic PICC workshop followed by extensive clinical experience in the insertion, use and maintenance of

these devices.The student will be able to demonstrate techniques for overcoming difficulties during use of the MicroIntroducer insertion technique.

The student will be able to articulate the potential complications associated with the MicroIntroducer insertion technique along with the nursing interventions for each potential complication.

Students will be able to accurately complete the cost justification worksheet, representing their individual facility circumstances.

The program instructors bring to you their experiences of hundreds of PICC/Midline insertions along with the vast experience of Bard Access

Systems, which encompasses thousands of catheter placements throughout the world.

The student will be able to articulate the steps used in the MicroIntroducer insertion technique for inserting a PICC.

The participant will be able to demonstrate MicroIntroducer insertion technique competence on an anatomical model in a laboratory skills practicum

Certificates of completion will be issued at the end of the workshop providing the participant has met the following requirements.


experience.

4. Pays appropriate fees


experience.

BARD ACCESS SYSTEMS5425 W. AMELIA EARHART DRIVE

SALT LAKE CITY, UT 84116

CLINICAL EDUCATION DEPARTMENT

CLASS RECONCILIATION FORM

Date: ### Class ID#: 0 Type:

FACILITY: 0TERRITORY MANAGER: =J17INSTRUCTOR: =J18

FEE RECONCILIATION

Total

Checks: x $ = $ -

Billing(Purchase x $ = $ - Order)

Free x $ 0 = $ 0.00

$ -

Number of Attendees

Rate Per Attendee

Total Number of Attendees

Fees Collected

Must agree with

attendance record

Must agree with check and billing included in

packet

NOTE: THE PURCHASE ORDER FORM MUST BE FILLED OUT AND INCLUDED IN THIS PACKET WHEN A PURCHASE ORDER NUMBER IS

PROVIDED AS METHOD OF PAYMENT.

Basic Groshong

Basic Per-Q-Cath

Basic Neonatal

Advanced

Safety Inservice

Miscellanous

ID #: 0Date: December 30, 1899TM: ='Activity Justification Form'!Q9Facility: 0

Workshop Reminders

1.

2.

3.

4. Return packets should include:

Attendance RecordsEvaluationsFee Reconciliation FormPayment of Registration Fees

Note:

Send all Packets to: Bard Access Systems

C/O Tina Uhrhan

5425 West Amelia Earhart Drive

Salt Lake City, Utah 84116

Thank You

Tina Uhrhan, Clinical Education Coordinator, 1-801-595-5406

Please remember that the proper documentation and the payment for you class needs to be sent to the Salt Lake City home office within one week following each class.

Use the return the Attendance Record. Make sure that the participants have completed the entire record.

Ensure all class participants have handed in the Evaluations. Evaluation forms can be found at the end of the Manual. Packets will be returned to the TM if evaluations are not included.

Certificates must be issued the day of the class. Recipients are responsible for keeping the certificates and Territory Managers should inform class participants that there is a $10.00 processing fee and 6-8 weeks processing time for duplicates.

P.O. form filled out in its entirety if class will be paid through a P.O by the facility

Future classes will not be scheduled for Territory Managers with late or incomplete packets.

Basic Registration

Name:

Address:

City:

State:

Zip Code:

Daytime Phone ( ) -


Employer:

Fee Enclosed: 1

2

3

Please mail fee & registration to:4

Bard Access Systems5

Mayor1535 Vista Club Cr, #205

Santa Clara, CA 95054

1

2 Sterile technique refresher3

Program Approval

Provider approved by the California Board of Registered Nursing, Provider Number CEP 12028

for 10.2 contact hours.

The following didactic topics will be discussed to help clinicians choose the appropriate VAD for a

patient:

Indications and Contraindications for PICC and Midline Usage

We reserve the right to cancel the workshop due to insufficient registration.

Advantages and Disadvantages of PICC and Midline Usage

Advantages and Disadvantages of PICC and Midline Usage

Basic Anatomy and Physiology Review of the Veins of the Upper Arm, Chest and Central Venous System

Early Vascular Access Assessment Based on Diagnosis

In addition the following practicum topics will be discussed and demonstrated during a hands on insertion lab.

PICC and Midline insertion covering patient preparation, positioning, and placement technique

Discount fee by 20% if you belong to UNA – include a copy of your UNA Membership

Card PICC and Midline complication and care/maintenance management

This program is approved by the Utah Nurses Association as an approver of the Continuing Education for nursing by the American Nurses Credentialing Center Commission on Accreditation. This course work has been approved

for 10.2 contact hours.

An all day Interactive Workshop

Vascular Access DeviceInsertion Selection

& Management

Vascular Access DeviceInsertion Selection

& Management

Workshop Information Program Schedule About the InstructorFeb 13th, 2007

7:30 – 7:45 Registration

0

Stanford Center for Education 7:45 – 8:00 Welcome/Introduction

1451 S. California Av 8:00 – 9:00 Anatomy of the Arm/Chest

Palo Alto, CA Indications and

Contraindications of PICC &

Midlines

9:00 – 9:15 Physiology of bloodflow

9:15 – 9:30 Osmolality, Osmolarity, and drug pH

TM 9:30 – 9:45 Break

1-800-443-3398 9:45 – 10:15 Device selection & the cost of IV Therapy

Ext. 0 Refund Pollicy10-15 – 10:45 Patient assessment

10:45 – 11:15 Vein access techniques

11:15 – 12:15 Insertion procedure & video demonstration

12:15 – 1:15 Lunch

Describe PICC/Midline insertion competency guidleines1:15 – 2:15 Use and Maintenance

Target Audience

Define Peripherally inserted Central Catheters/Midlines.2:15 – 3:15 Complication Management

3:15 – 3:30 Break

3:30 – 4:00

The Program

Locate and select veins used for PICC/Midline insertion.4:00 – 6:00 Practicum

6:00 – 6:15 Evaluations

Completion Requirements

1. Attends the entire workshop2. Completes the practicum 3. Pays the appropriate fee

For further information on this offering please call:


Tuition will be refunded (less a $10.00 processing fee) if notification is received no later than seven days prior to the workshop. Notification

may be verbal or in writing. Participants may also elect to send another person in their place.

This workshop targets the experienced IV clinician who wants to start inserting PICCs and Midlines. Although the primary focus of this workshop is for Registered Nurses, other healthcare professionals are welcome to attend. Educational contact hours will be awarded to RNs. This workshop also qualifies as a refresher course for those already inserting PICCs/Midlines.

Identify clinical indications for PICC/midlines placement using early assuessment protocol.

Identify patients who will benefit from PICC/Midline placement.

Outcomes monitoring legal issues Patient Education

Identify methodologies for securing a physician's order for PICC/Midline insertion.

The program instructors bring their numerous experiences with PICC/Midline insertions along with the vast experience of Bard Access

Systems, which encompasses thousands of catheter placements throughout the world.Describe potential complications, prevention, and care

associated with PICC/Midline insertion and central venous access devise management.

Describe the correct stie care and maintenance protocols associated with PICCs/midlines

NOTE: The workshop begins promptly at 8:00 am. Late arrivals may attend the remainder of the workshop

but will NOT receive a certificate of completion.

Describe the importance of data collection and a quality management program. Certificates of completion will be issued at the end of the workshop

providing the participant has met the following requirements.Demonstrate insertion competency on an anatomical model in a laboratory skills practicum.

Type Date here

Nadine NakazawaPicc nurseStanford Center for Education1451 S. California AvPalo Alto, CA

Dear Nadine Nakazawa

Education Contact HoursCertification

Your Workshop has been scheduled for:

Date: Feb 13th, 2007Place: Stanford Center for EducationTime: 12:00 AMRegistration Fee: $150.00 Bard Territory Manager: Mayor

Supplies will be:#########

Enrollment:

Thank you for your interest in our Basic PICC and Midline Workshop. This letter is to confirm the date of the Workshop and to provide you with some information so that the Workshop runs smoothly and efficiently.

As host, please inform the participants before the Workshop (no later than the morning of the Workshop) of the following sections:

A minimum of 10 participants is required before a workshop will be provided. Please discuss attendance with the Territory manager, including the maximum number of attendees appropriate for this workshop. Please contact the Territory manager a minimum of seven (7) business days before the workshop with a final number of participants. This will ensure that a sufficient amount of materials will be available for the workshop.

Shipped to your Facility

Brought to the class by the Territory Manager

Educational Contact Hours:

Certification to Place PICCs and/or Midlines:

Materials for the Workshop:

Workbooks (one for every participant)PICC and/or Midline Product for the Practicum portion of the workshopPaperwork (attendance records, certificates of attendance, etc.)

Classroom Requirements:

10.2 contact hours will be provided to all RNs who attend the entire workshop. Partial credit cannot be given. It is approximately 8 hours of didactic information and a 2 hour practicum where participants practice simulated insertions on a model arm. Bard Access Systems does not allow live insertions to be performed during the workshops. Physicians, LPNs, etc. are welcome to attend the workshop, depending on your needs, but they will not receive educational contact hour credits.

It is the responsibility of the participant to keep the certificate of attendance for 4 years. If the certificate is lost, a duplicate copy can be obtained from Bard Access Systems after the participant’s attendance is confirmed. Processing time is two weeks.

Attending the Bard Access Systems workshop does not certify the RN to insert PICCs and/or Midlines. At this time, there is not a governing body that provides RN certification of PICC and/or Midline placement. Certification to insert PICCs and/or Midlines must be done by the RN’s employer. Only the employer can determine what “certification” means to a specific institution/agency. These criteria should be specified in the institution’s PICC/Midline Policy and Procedure. Your institution/agency must define what “certification” will be at your institution/agency.

You will be receiving the following workshop materials several days prior to the date of your workshop or the Bard Access Systems Territory manager will bring them the day of the workshop.

The Bard Access Systems Territory Manager will bring these items on the day of the workshop or have them shipped directly to you a few days before the workshop. If materials are being shipped to you, they will come in multiple boxes and deliveries. You will need to open all packages to assure that all items have arrived. If you are missing any of the above items, please contact the education department at 1-800-443-5505, ext. 4981, as soon as possible.

The classroom should be large enough o hold the expected number of participants in a comfortable classroom setting. The best set-up is classroom style with 6’ X 18 – 24” banquet tables with comfortable chairs. While we realize that every facility may not have this set up available, every attempt should be made to closely approximate it.

35 mm Kodak carousel compatible slide projector with screen, remote and a spare bulbPaper flip chart )preferred) or dry board (with markers) or chalk board (with chalk)Upright podium at the front of the room6’ table (18 to 24”) at the front of the room

Sincerely,

Connie B. MinenEducation Coordinator

Room temperature is extremely important. An environment too hot or cold is not conducive to learning. Please make sure the speaker knows the location of the thermostat control.

The following audio-visual equipment will be necessary and should be in the classroom by 7:00 AM on the day of the workshop:

Our staff is looking forward to assisting you with this important educational opportunity. Thank you for choosing Bard Access Systems. If you have any questions, please call our education department at (800) 443-5505, extension 4981.

BASIC WORKSHOP BINDER ORDER FORM

Bard Access Systems Education Department Date:

Shipping Information Method of Shipping__UPS Ground__UPS 3-Day__UPS 2-Day__UPS Overnight Afternoon__UPS Overnight Morning__UPS Overnight 1st Morning__Ship:

(Please call Tina Uhrhan at (801) 595-5406 with questions on this shipment.)

PICC Workshop

PICCMAN3

Bard Access Systems Office Use Only Date:

ProductQuantity Code Number

Notes:

Reference Number: P.O. Number: 0

Vascular Access Device (selection, insertion and management)

Today Tomorrow

ID #: 0Date: January 28, 2004TM: Autumn KilkerFacility: St. John Oakland Hospital

Workshop Reminders

1.

2.

3.

4. Return packets should include:

Attendance RecordsEvaluationsFee Reconciliation FormPayment of Registration Fees

Note:

Send all Packets to: Bard Access Systems

C/O Connie Minen

5425 West Amelia Earhart Drive

Salt Lake City, Utah 84116

Thank You

Connie Minen, Sales Assistant, 1-800-595-5406

Please remember that the proper documentation and the payment for you class needs to be sent to the Salt Lake City home office within one week following each class.

Use the return the Attendance Record. Make sure that the participants have completed the entire record.

Ensure all class participants have handed in the Evaluations. Evaluation forms can be found at the end of the Manual. Packets will be returned to the TM if evaluations are not included.

Certificates must be issued the day of the class. Recipients are responsible for keeping the certificates and Territory Managers should inform class participants that there is a $10.00 processing fee and 6-8 weeks processing time for duplicates.

P.O. form filled out in its entirety if class will be paid through a P.O by the facility

Future classes will not be scheduled for Territory Managers with late or incomplete packets.

Documents

Stanford Picc Class Feb 13th 2007