When Glenda Dennis arrives for her interview, this 70-year-old nurse is, as expected, dressed in scrubs. It’s been her way of life for decades.
Dennis’s commitment to her profession has meant not only treating patients with the highest level of care, she also began practicing a new procedure for inserting PICC lines that she now offers in a mobile service.
While working as a nurse at McKenzie-Willamette Medical Center in 2008, Dennis became the first person to bring the procedure for inserting peripherally inserted central catheter, or PICC, to the United States.
When drugs or medications are delivered, much of the time in a hospital setting, they are administered by standard IV lines which are usually inserted into a vein in your wrist, elbow or the back of a hand.
A standard IV line can be kept in place for up to four days, which means that medications can be administered with no more “pokes.”
While IVs have advantages that work well for short-term needs for pain medications or antibiotics, they don’t work for long-term drug delivery such as chemotherapy or long-term feeding needs, because the pH of the chemicals that are injected eventually destroys the vein tissue.
In this case, the patients receive a central venous catheter (CVC) instead of a standard IV catheter. A CVC is inserted into a vein in your neck, chest, arm or groin area. It can stay in place for several weeks or even months.
A PICC has a long line that sends medication from the area of insertion, through your blood vessels, all the way to a vein near your heart. A PICC is typically placed in a vein above your elbow in your upper arm.
“The catheter goes to the vena cava, which is the major circulation point for blood flow to your heart,” Dennis says. “There is enough blood flow there that it dilutes the substance, so it doesn’t mess up a person’s veins.”
The placement of catheters was done only by a physician in a hospital setting. In the early 1990s, nurses began performing the procedure, which required the nurse to keep the insertion site sterile while the nurse and the patient waited for the mobile radiology unit to visit the patient’s bedside to show that the catheter was in the right spot.
“This was difficult for a few reasons,” Dennis says. “It was more expensive for the patient, it exposed them to more radiation, and the chest X-ray did not always show a very precise location. Also, there was a delay in getting the patients their medications as we had to wait for the positioning confirmation. This new method changed all that completely.”
The new method, which Dennis learned from physician colleague Dr. Peter Rothenberg, utilized a catheter with a small wire on the end of it that transmitted signals from the heart via electrocardiogram (ECG or EKG) patterns transmitted through small electrode patches.
“By using ECG to place the catheter you could do it bedside without the X-ray and it saved the patient the cost for the radiologist to read it,” Dennis says. “And it’s actually more precise than the chest X-ray because it’s a two-dimensional thing. It saved me a huge amount of time because sometimes I’d stand there for a half hour, 45 minutes, trying to keep the area sterile.”
In 2009, Dennis presented her new-found knowledge to the staff at McKenzie-Willamette — with a mixed reception.
Some physicians outright discouraged her from sharing this knowledge or using this technique. Dennis didn’t realize it at the time, but she was the first nurse in the United States to use ECG guidance to place PICC lines. Soon, she was inserting PICC lines into the patients of these skeptical doctors, and this placement method has become the new gold standard.
“When I realized I was the first I was astounded, but then I was excited because it does so much good for the patient and we can reduce time and money involved in putting in a PICC line and they can stay in for up to two years,” she says.
A family of nurses
Dennis grew up on a dairy farm and her early life might not have seemed like it would lead to this remarkable achievement.
Yet, she comes from a family of nurses. “It’s a genetic thing,” she says, with sincerity.
Both of her daughters are nurses, along with both grandparents, her mother, her aunt and also an uncle.
Dennis’s grandmother, who graduated in 1914, was one of the first registered nurses in the state of Missouri. She met her husband while they both were nurses at the sanitarium (hospital) in that state.
Dennis knew from a young age that nursing would be her career. She raised her children while working, which included 25 years in the intensive care unit. At one point she transferred to management, then went back to the ICU after realizing that working directly with patients was what made her happiest. She retired in 2013, and brought together a small team who had expressed interest in her PICC work.
Dennis and her colleagues formed a business this past January, delivering these services to a location convenient for patients. Dennis’s daughter, Robyn Smith, also a PICC nurse, came on board. AIMS Vascular Access is named to honor a close friend and fellow nurse, Elizabeth Ames, who passed away without getting to be part of the company.
“Elizabeth was a dear friend who had worked with me for many years in the intensive care unit, then joined me in starting the vascular access team,” Dennis says.
AIMS contracts with several physicians to do PICCs at their offices, and the physicians they have on staff also refer patients in extended care facilities and in the hospital.
They have contracted with several specialty pharmacies who refer patients to them who don’t need to go to a hospital for catheter insertion and infusions.
With her interview completed, Dennis packed up and headed back to work— ready to help another patient with a PICC line insertion.
“I truly have a passion for the IV therapy and bringing it to the patient, so that patients can stay where they’re comfortable, whether they are in their home, in their doctor’s office or in a hospice setting,” Dennis says. “It feeds me.”