Hello all,
Who places US PIVs in your facilities (obviously scope of practice is pertinent)? And since I'm at it it...what about midlines? IV/VAT team members & LIPs only... specially trained unit staff? Is the answer different in specialty units (ex: ER or ICU)? How do you do quality monitoring for those outside "the team"?
Thanks in advance!
Please consult your state board of nursing for all questions of scope of practice. Competency must be documented for any skill / procedure. See the 2016 INS Standards of Practice.
R. Terry Jones, RN, CRNI, VA-BC
Memorial Hermann Northeast Hospital
Humble, Texas
These are scope of service questions that must be decided by your organization. From what I see, a midline catheter is predominately inserted by a specialized infusion/VA team and NOT every staff nurse. Reasons include - proper assessment of indications for a midline; site selection in the upper arm not a common place for med-surg nurses; sterile technique with max barriers; plus mastery of US insertion requires dozens of insertions. Not enough patients and midline insertions to go around for every med-surg nurse to become competent.
The next issue is competency assessment and validation. Becoming competent is the responsibility of the professional. Assessing and validating competency is the responsiblity of the organization. See new INS standard on this issue. US PIVs require competency assessment and validation, again with numerous insertion attempts. Scope of practice is defined in each state by the governing boards and it varies by state. So first you must find these rules and regulations for any group of professionals you want to have placing US PIV or midlines. Then set up the process for competency assessment and validation which includes knowledge acquisition, critical thinking, psychomotor skills.
Finally your infusion team should have the responsibility for QI on ALL VADs of all types in my opinion. You are the experts! 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
My thank s to Lynn and Terry for their input, but I was looking more for how facilities determine who they are going to allow to perform these services (especially outside of their access teams if they do allow others to do US PIVs) and how they impemented QI for them. We have had interest from some ER staff (MDs and RNs) in learning US PIVs.
Keely
Keely Ralston RN-BC, VA-BC, CPUI, RCIS
ER staff should definitely have the skill of using US for difficult PIVs. This is required in ER patients. Unless your infusion team can meet the immediate need for this service in the ER ER RNs must be able to do it. After hospital admission, the infusion team provides this service. 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
ER staff should definitely have the skill of using US for difficult PIVs. This is required in ER patients. Unless your infusion team can meet the immediate need for this service in the ER ER RNs must be able to do it. After hospital admission, the infusion team provides this service. 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