Vascular Access Device Competency and Credentialing Checklist

This checklist compiles the competency verification elements required for each level of vascular access practice — from peripheral IV placement through implanted port access. It is intended for use by vascular access educators, nursing leadership, and credentialing committees as a reference framework. Adapt to institutional protocols and regulatory requirements as needed.

How to Use This Checklist

Purpose: This framework defines the minimum competency elements for each VAD privilege level. Use it to:

• Design or audit institutional credentialing programs
• Verify individual practitioner competencies during initial training and annual review
• Document training and supervised procedure completion for privileging files
• Benchmark your institutional credentialing program against AVAR and professional standards

Scoring: For proctored competency observations, use a pass/fail or 1–4 scale for each element. Minimum passing threshold should be defined by institutional policy (typically ≥85–90% on observed competency).

Documentation: Retain completed checklists in the practitioner’s credentialing file. Annual competency re-verification is required for each privilege level.

Level 1: Peripheral Intravenous Catheter (PIV)

Didactic Knowledge Requirements

• Peripheral venous anatomy: forearm, antecubital, hand, foot
• Gauge and catheter selection by indication and patient age
• Infection prevention: hand hygiene, aseptic technique, skin antisepsis
• Assessment: phlebitis (VIP scale), infiltration (staging scale)
• Indications, contraindications, and limitations of peripheral access
• current clinical standards for dwell time, dressing, and device removal

Simulation

• Completed minimum 1 simulation session on vein-and-skin phantom
• Demonstrated correct tourniquet application and release timing
• Demonstrated correct needle angle and advancement
• Demonstrated correct catheter advancement after flash
• Demonstrated correct securement and dressing application

Proctored Clinical Cases

• Minimum 5 proctored PIV insertions (or per institutional policy)
• ≥80% first-attempt success rate across proctored cases
• Proctor attestation of competency for each case (date, patient ID, proctor signature)

Observed Competency Checklist (for each proctored case)

Before insertion:

• Patient identification using two identifiers
• Hand hygiene performed
• Appropriate site selected (avoids joints, antecubital for short dwell, hand preferred)
• Tourniquet applied correctly
• Skin antisepsis with correct agent and technique (CHG/IPA or 70% IPA, friction, dry time)
• Appropriate gauge selected for indication

During insertion:

• Correct needle angle (15–30°) for peripheral access
• Flash of blood recognized; needle angle lowered
• Catheter advanced smoothly over needle; needle withdrawn without contaminating tip
• Blood return confirmed before connecting tubing
• Tourniquet released before flushing

After insertion:

• Flushed with 3–5 mL NS without resistance; no swelling or patient complaint
• Securement device applied correctly (chevron tape or commercial securement)
• Transparent semipermeable dressing applied without tension on catheter
• Date, gauge, inserter initials labeled on dressing
• Patient education provided (signs of phlebitis/infiltration to report)
• Insertion documented in EHR (site, gauge, attempt number, date/time)

Annual maintenance:

• Annual competency observation or simulation requirement
• Minimum insertion volume maintained (per institutional policy)

Level 2: Midline Catheter

Additional Prerequisites Beyond Level 1

• Level 1 (PIV) competency current
• Completed midline-specific didactic (anatomy, dwell, site selection, osmolarity limits)
• Ultrasound Level 1 competency (or midline-specific US training, if using US guidance)

Didactic Knowledge Requirements

• Midline anatomy: basilic, cephalic, brachial veins of the upper arm
• Midline vs PIV vs PICC: appropriate device selection
• Osmolarity limitations: ≤600 mOsm/L; no vesicants, no PN
• Dwell time: up to 14–29 days per institutional policy
• Dressing change intervals and securement for midline
• Flushing and locking protocol (SASH; saline or low-dose heparin lock)
• Contraindications: prior DVT in arm, mastectomy/axillary dissection, lymphedema

Proctored Clinical Cases

• Minimum 3–5 proctored midline insertions (per institutional policy)
• Proctor attestation including tip location documentation method

Observed Competency Checklist

All Level 1 elements apply, plus:

• US guidance used for vein identification (documented)
• Vein diameter assessed and documented (target ≥4 mm)
• Catheter-to-vein ratio assessed and within acceptable range
• Catheter length measured and trimmed to appropriate midline length (tip in axillary/subclavian)
• Blood return confirmed from catheter hub
• Post-insertion documentation includes: arm used, vein cannulated, insertion site (cm from antecubital), external catheter length, blood return status

Level 3: PICC Line Insertion (Ultrasound-Guided)

Prerequisites

• Current RN license
• Level 1 (PIV) competency current (or equivalent clinical foundation)
• Completed PICC-specific didactic training program (minimum 16 hours)
• Ultrasound credentialing — PICC level (see Section 7)

Didactic Training Modules (Minimum 16 Hours)

• Module 1: Upper extremity venous anatomy for PICC (basilic, brachial, cephalic; axillary/subclavian to SVC)
• Module 2: PICC device selection (gauge, lumen count, power-injectable, valved vs open-ended)
• Module 3: CLABSI insertion bundle and sterile technique for PICC
• Module 4: Ultrasound guidance for PICC (anatomy identification, short-axis/long-axis, in-plane technique)
• Module 5: Modified Seldinger Technique (MST) — needle, guidewire, introducer, catheter sequence
• Module 6: ECG-guided tip confirmation and CXR interpretation
• Module 7: Complication recognition and management (DVT, malposition, air embolism, arterial injury)
• Module 8: Post-insertion documentation and patient education

Simulation (Minimum 4 Sessions)

• Ultrasound vein identification on commercial arm phantom
• Guidewire handling and MST sequence on vascular access trainer
• Long-axis in-plane technique practice
• ECG tip confirmation simulation (P-wave recognition)

Knowledge Assessment

• Written/electronic exam: ≥80% passing score
• Exam covers: anatomy, device selection, bundle compliance, complication management, documentation

Proctored Clinical Cases

• Minimum 10–15 proctored PICC insertions (per institutional policy)
• ≥85% first-attempt success rate across proctored cases
• ≥90% compliance on competency checklist across all proctored cases
• Cases documented: date, patient MRN, vein, arm, gauge, lumen count, tip position, proctor name/credential, checklist score

Observed PICC Competency Checklist

Pre-insertion:

• Correct patient identification (two identifiers)
• Review of arm contraindications (bilateral mastectomy, ESRD/CKD vessel preservation, prior DVT)
• Bilateral arm US survey completed; arm selected based on vein survey
• Vein documented: diameter, depth, compressibility, absence of thrombus
• Catheter-to-vein ratio calculated and documented (target ≤45%)
• Catheter length estimated from insertion site to CAJ (anatomic measurement)

Insertion bundle:

• Hand hygiene performed (soap/water or alcohol rub)
• Maximum sterile barrier precautions: sterile gown, sterile gloves, mask, cap
• Patient draped with full-body sterile drape
• Skin antisepsis: CHG/IPA, back-and-forth friction ≥30 seconds, fully dried before proceeding
• Tourniquet applied over sterile drape or aseptically

Sterile field management:

• Sterile field maintained throughout; no breaks or contamination events
• All supplies opened onto sterile field without contamination
• Catheter flushed with NS before insertion

Ultrasound insertion:

• US probe in sterile sheath; gel applied inside sheath
• Vein identified and compressibility confirmed at insertion site
• Long-axis in-plane or short-axis out-of-plane technique performed correctly
• Needle tip visualized in vessel lumen before guidewire insertion
• Guidewire echogenicity confirmed in vessel on US before removing needle

Catheter placement:

• Introducer placed over guidewire using correct technique (no kinking, no guidewire loss)
• Catheter advanced smoothly to pre-measured length
• ECG P-wave monitored during advancement (if ECG-capable system in use)
• Tourniquet released before cap/hub application
• Blood return confirmed from all lumens before dressing
• Catheter secured and transparent dressing applied

Post-insertion:

• Tip position confirmed (ECG: maximum upright P-wave; or CXR ordered)
• Documentation complete: arm, vein, insertion site, external length, tip position, gauge, lumen count, blood return, bundle compliance
• Patient education: activity restrictions, signs to report, follow-up plan
• Insertion note in EHR completed within required time frame

Annual maintenance:

• Minimum 12 PICC insertions per year to maintain competency
• Annual competency review (observation or simulation)
• Re-proctoring required after ≥6-month absence from PICC insertion

Level 4: Central Venous Catheter (CVC) Insertion

Note: Non-tunneled CVC insertion by nurses requires specific state scope of practice authorization and institutional privilege. In most US facilities, non-tunneled CVC insertion is a physician/PA/NP privilege with a separate credentialing track.

Physician/APP Credentialing Elements

• Formal CVC training (residency/fellowship or structured didactic + simulation program)
• Ultrasound guidance credentialing (see Section 7)
• Minimum 10–25 proctored CVC insertions by insertion site (IJ, subclavian, femoral)
• Knowledge assessment: anatomy, site selection, CLABSI bundle, pneumothorax management

CVC Insertion Competency Checklist (Key Elements)

• Patient positioning confirmed (Trendelenburg for IJ/subclavian)
• US guidance used for IJ and subclavian (real-time dynamic guidance)
• Seldinger technique performed correctly (needle, wire, dilator, catheter sequence)
• Guidewire maintained under control at all times (external portion not released)
• CXR ordered and reviewed before use: tip at CAJ; no pneumothorax; no hemothorax
• CLABSI insertion bundle compliance documented on procedure note

Level 5: Implanted Port Access (Huber Needle)

Prerequisites

• Current nursing license
• Completed port access training module (anatomy, Huber needle, ANTT, sterile technique)

Observed Port Access Competency

• Port identified and type confirmed (power vs standard)
• Port location identified and ANTT field established
• Skin antisepsis: CHG/IPA applied and dried
• Huber needle correct gauge selected; non-coring needle confirmed
• Port palpated and stabilized with non-dominant hand (three-finger technique)
• Huber needle inserted perpendicular to septum; resistance felt at septum, then needle seats in reservoir
• Blood return confirmed; flush with 10 mL NS without resistance or patient complaint
• Dressing applied over needle for continuous access or needle removed with positive pressure for intermittent
• Deaccess: flush and lock with heparin (100 units/mL, 5 mL), remove Huber needle while maintaining positive pressure on plunger

Section 6: Ultrasound Credentialing for Vascular Access

US-PIV Credentialing (Minimum Program)

• 1–2 hours didactic: US physics basics, vein vs artery identification, short-axis technique
• 2–4 simulation sessions on arm phantom
• 5–10 proctored US-guided PIV insertions
• Knowledge check: ≥75% exam score
• Annual: maintain ≥10 US-PIV insertions per year; annual competency observation

US-PICC Credentialing (Embedded in PICC Credentialing)

As documented in Level 3 PICC checklist:

• 8+ hours US-specific didactic (vascular anatomy, short-axis/long-axis, in-plane/out-of-plane techniques)
• 4+ simulation sessions
• US technique competency documented on PICC insertion checklist
• Annual: maintain ≥12 PICCs per year (with US guidance documented)

Section 7: Annual Competency Summary

Complete for each privilege level maintained:

Volume thresholds for competency maintenance:

• PIV: No minimum specified; daily clinical practice assumed
• Midline: Minimum 6 per year (or per institutional policy)
• PICC: Minimum 12 per year; re-proctoring after 6-month gap
• Port Access: Minimum 6 per year (or per institutional policy)

Related Resources

Related guides:

• VA-BC Certification Guide
• PICC Insertion Competency Framework
• Ultrasound Credentialing for Vascular Access
• Institutional Privileging Framework

Related resources:

• CLABSI Prevention Framework
• Vascular Access Safety Report

References

2. Association for Vascular Access (AVA/AVAR). (2022). Competency and credentialing standards for vascular access. CBVN/AVAR.
3. The Joint Commission. (2024). Nursing care standards: competency verification requirements. TJC Comprehensive Accreditation Manual.
4. Moureau NL & Trick N. (2009). Building a PICC competency and credentialing program. J Assoc Vasc Access, 14(3):164–171.
5. AIUM. (2019). Practice parameter for the use of ultrasound to guide vascular access procedures. J Ultrasound Med, 38(3):1–13.