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mharman
PICC RN's "interpreting" PCXR

Just wanted to post a note regarding this practice.  My facility recently sent three members to a class on interpretation of the chest film by RN's.  The class was great and we learned alot; however.....After speaking personally to the Executive Director of the Virginia State Board of Nursing, I have been told we are NOT permitted to do this in this state.  This is not a State Board decision, but one that would require a change in Virginia State Law through the state assembly.  The law defines who can interpret/read radiologic films and it does not extend to the nurse in any situation.  Thanks, Mally Harman, RN, BSN

kathykokotis
x-ray

First off no RN can read or interpret a film that is correct.  In many states however RN's can view an x-ray and determine if the tip according to anatomical landmarks is at the SVC junction.  It sounds as if your state is not an algorithm decision making state therefore I would put together a package with a copy of all the states allowing this practice and send it to Virginian for approval.  You will find a nice JVAD article published in 2009 with states allowing this procedure as well as the posiition paper from INS.  Jamie Santolucito can send you a package to petition your state board

Kathy Kokotis RN BS MBA

Bard Access Systems

mharman
I understand that an RN

I understand that an RN cannot read/interpret a film for the purpose of diagnosing.  We were hoping to be able to release the PICC for use once we viewed the tip in the proper place and radiology would confirm within 24 hours.  We were developing a policy for our facility as well.  The radiologist were in great support and were going to help develop a training program. This practice was what was taught at the class.  I discussed at length with the State Board how to go about allowing this.  There is no situation in which we will be permitted to do this. It is considered outside the scope of practice for the Virginia RN.   She informed me I could lobby the State Assembly for a change in the law.  However, that is a costly and time consuming venture.  Virginia is not an alogorithm state it is an advisory board state. The information we received can be used to perfect our practice of insertion and competently talk with our radiology group, but nothing else.  Mally Harman, RN, BSN

Mally Harman, RN, BSN
Vascular Access Team Coordinator
Centra Health
Lynchburg, VA
434-200-2647

lynncrni
I was afraid that would be

I was afraid that would be the outcome. It sounds like changing this would require opening the nurse practice act. In addition to being costly and time consuming, opening the law could allow other changes that could be a problem. I have known about other situations in VA where the law and state board seemed to be behind the times. While you can not assess the chest xray and formally document decisions based on your assessment, it is good that you want to incorporate this into your practice to enhance communication and patient safety. 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

Melanie Heisner
The same thing happened to us

The same thing happened to us in Alabama. We submitted our package to the board and were told that you have to be a nurse practitioner to interpret chest xrays. Unfortunate for the patient because this weekend I waited 3 hours for a radiologist to read a chest film for a patient in critical care who desperately needed the line for incompatible meds to be started.

lynncrni
I would continue to work with

I would continue to work with your board of nursing and not be satisfied with the first rejection. It sounds to me like a matter of educating the board about the differences between "reading" or interpreting a chest xray, where you are looking at the total film for pathology, etc versus assessing a chest xray for catheter tip location. I would totally agree that nurses are not reading or interpreting a chest xray but we are assessing for tip location. Do ED or ICU nurses in your state ever look at films for placement of other types of tubes? If so, there is precedent and the nurses on the board are not understanding what you want to do. That or antiquated thoughts from some very old nurses on that board!! 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

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