Good morning everyone,
Our facility has added midlines and now AccuCaths to our vascular access options. Current policy is that midlines may dwell for 30 days and PIV's for 96 hours, unless an order is obtained to keep in place. With the addition of the accucaths and knowing the pro's of clinically indicated removal we have started the process of adopting a clinically indicated removal policy versus a time frame.
It was presented, in part, before our nursing care and practice council that oversees and approves all poilcy changes, and we are getting some puch back. There are concerns re: infection and whether the change is needed as we can call a physician for an order to retain a good line anyhow. Based off of research, it seems like the infection point is moot, and calling on every patient seems burdensome and a waste of time.
Does anyone have any advice on how to sell this to the council or any experience with implementing this at your facility?
Thanks!
Micah
That physician's order provides NO protection for the nurse, zero, zip, nada, nothing! The nurse is making the assessement and the decision about whether there is a clinical indication to remove any VAD, not the physician. Any sign or symptom of any complicaiton including pain or discomfort is a clinical indication to remove any PIVC, short or long design. The physician is not seeing or hearing the patient when you call with this question. It does not matter whether it has been in for 2 hours, 2 days or 2 weeks. This is nursing responsibility and nurses are held accountable for the appropriate action to remove the catheter when there is an issue. Courts hold nurses accountable because we are knowledgable decision makers, not handmaidens following orders.
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
Lynn,
Thanks for the response. Maybe I should clarify...the order is to retain the line longer than 96 hrs, with the unwritten caveat that the nurse will remove it as soon as clinically indicated. It doesn't make sense to me to even involve the physician in a decision like this. As you said - we are knowledgeable decision makers, and to be quite honest, I think that scares some people.
M.K.
ICU Nurse
RN, PHRN, VA-BC, NRP
Yes, I understood your question, but a physician order is not going to do a thing to protect that nurse if anything goes wrong and a lawsuit results. This is all nursing domain, nurisng judgment and nursing decision making. The courts are very clear about nurses being decision makers. But I can see how some other might be intimidated by it. My new thing is an effort to practice at the top of our nursing license. This is one example of how we can and should be practicing at the top and I can think of a long list of others.
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
BRAVO!!....that was well put Lynn. Nurses should aim to practice at the TOP of our license. Far to often this is not the case
Lynn,
I see exactly what you are saying. To me, its not so much about CYA in regards to getting an order as much as it is asking "mother may I" and giving away our practice to a physician. To me it still is going back to where "the physician knows best" and we're "just nurses". After all, the physician wouldn't let us keep it in if it weren't best for the patient, right? (all sarcasm on my part).
I wholeheartedly agree in regards to our practice. There is nothing more frustrating to me than giving up what is well within our scope to any other practice (physician or otherwise), especially because "that's the way it's always been." And why should my practice be limited because other nurses don't want to operate at the top of their scope?
I too believe that IV therapy and access is just the tip of the iceberg.
M.K.
ICU Nurse
RN, PHRN, VA-BC, NRP
Hi Micah,
We implemented clinically-indicated in May 2018. Prior to implementation we followed the patients/PIVs to determine a baseline for dwell time and complications. My concern was that we would extend to clinically indicated and then have complications, then have to retract to 96-hours, if we didn't have comparison data. The initial project came from a Shared Governance Council so we had a small team to assist with the assessments and tracking. The rate of complications went down after introducing clinically-indicated. Perhaps someone in your institution is looking for a school project, SG project, yellow-belt, green belt... or maybe just one unit can trial this.
Carole