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mamirhekmat
CV techs and Respiratory Therapists placing Picc's and Central lines.

It is our understanding that in Arizona, CV techs and Resp Therapists are placing not only PICC's but
central venous cathers including using the subclavian approach through the thorax . We feel that this is
getting out of hand but don't know where to start addressing this issue. What is your experience and what
are your suggestions?
Maureen Amirhekmat RN, CRNI

kathykokotis
Respiratory therapists

You are not going to like what I say and this is in my AVA talk. There are now (5) hospitals in Arizona and growing that allow respiratory therapists to place PICC Lines. I met one of the teams two weeks ago and they are awesome. They track outcomes, do all dressing changes, and have an assessment program. They are 24/7 so I am not going to discount their ability one bit to do PICC lines. I researched the practice act for respiratory therapists in every state on their website and there is no exclusion for performing a central line. Nurse practice act does not dictate the practice act of a respiratory therapist as they work under the guidance of an MD and RN's no not. Banner Estralla has now done 150 IJ, subclavian lines with great success. IMHO as the article in the Nursing Administration Quarterly that they published there is a potential you are looking at the future. As reimbursement for CVC's declines and malpractice riders for MD's increase and they are being forced into ultrasound, MD's are giving up CVC placement. I believe respiratory therapy teams have the potential for growth as they have the labor supply, they are 24/7, and their practice as it is supervised by an MD Director allows it. I would ponder this future. Everyone is replaceable. We replaced the MD's in IR PICC line placement did we not? I know one thing for sure our own Nurse Practice Act in some states prevent us from doing the IJ, subclavian. If you want the future to be RN's that is where I would focus the energy in getting the practice act to open up by using the respiratory therapists as examples. This may open nursing boards for RN's to progress forward themselves. Than comes the question of response time. With sepsis bundle on the forefront and response time being critical the respiratory therapist is poised to take this on as they are 24/7. The RN teams would have to readjust their thinking process
kathy
Kathy

lynncrni
I strongly believe the entire

I strongly believe the entire hospital administration must adjust their thinking on the entire process of infusion therapy. I am not limiting this to just insertion of any vascular access device. That is only the first hour of the catheter's life. The outcome for that catheter depends on the nursing care the patient with the device receives. Kathy, I vehemently disagree that RN's "replaced the MD's in IR PICC line placement". Infusion nurse specialist were doing this procedure from the middle 1970's. IR tried to take it over but did not succeed, so RN's moved back into this practice. You make it sound as if the whole idea of PICCs started with IR - totally not true!!

I do strongly agree with you, however, that nurses must be more responsive to patient needs. If there is a need for a PICC at 2 am, then there must be a process for insertion at 2 am. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

kathykokotis
ultrasound

We did not use ultrasound back than. We did infringe on the IR territory when we picked up the usage of ultrasound. That is the only way we increased our success. You can say we stole ultrasound from the IR. Although as I recall we had to take some RN's kicking and screaming all the way into the future. There are still some dinosaurs left. We will now have to take the RN's kicking and screaming into the thought that a PICC line is not an emergent procedure. It is emergent or we are replaceable.
kathy

lynncrni
I think you meant to say that

I think you meant to say that a PICC insertion can be an emergent procedure. I would suggest that you read my blog entry PICC Insertion in the ED? http://hadawayassociates.blogspot.com/2009/08/picc-insertion-in-ed.html
Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Chris Cavanaugh
Arizona is not the only state

There are other states that allow PICC lines and CVCs to be placed by other practioners outside of RNs and MDs. The practice of CVC placement by RNs is also starting to be accepted by hospitals on an individual basis. It is time to move forward from IV nurses and PICC nurses to VASCULAR ACCESS SPECIALISTS and not only assess patients and recommend the best line for them but also be able to place these lines in the safest possible way, then continue to monitor and care for these lines until they are no longer needed. That is the future of vascular access. Multidisiplinary Vascular Access teams already exist and where they do, they are providing the best outcomes for the patients they serve.

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

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