I plan to take CRNI exam in March.
There have been many disagreements about CVAD partial occlusions in my facility. Tonight I challenged a doctor who claimed that the partial occlusion to the triple lumen Chest Inserted Central Catheter's distal port was due to the suture being too tightly drawn and that it was okay to use.
My reading of the INS Publication Nursing Practice Management, volume 1, number 2, March 2008; New Standards for Catheter Occlusion Management tells me:
1. Unacceptable to infuse through a partially occluded CVAD port.
2. Unacceptable to continue the other ports of a CVAD with an occluded port and
3. Tight Sutures causing an external mechanical occlusion should be removed.
He was not impressed. He questioned to authority of these "standards". I told him they are the standard nurses are judged against in court.
Am I wrong? He said I was.
Art Hansen, RN
Yes and no to your question about standards. The document produced by INS is called the Infusion Nursing Standards of Practice. The content of this document establishes the legal standard by which all nurses are measured if there is any legal issue. This document should also be used to write your internal policies and procedures. So you are correct about that.
The other publication from INS is like any other published article. It adds to our body of knowledge to enhance our practice and improve patient safety and better outcomes. Since it is a newer publication, there could be new evidence in that article than what was available when the Standards document was released in Jan 2006. While the article is not labeled as a standard per se, it could be used as evidence to guide practice decisions and could be used in any lawsuit to support your practice decisions. I know the publication to which you refer, but I do not remember the exact content of that article. I do not know what references were included, etc. In any lawsuit, it all comes down to which sides experts are the most believeable and acceptable to the jury, if it goes to trial.
The goal today is evidence based practice. All professionals should be open to the evidence regardless of which profession produces it, however we have not reached this goal with some physicians. So we must continue to educate them while remaining firm in our position to advocate for safe patient care. In my opinion, that is what you did. I would establish a hospital policy and procedure for managing this complication. After this internal document has gone through the proper committees, no physician can alter the policy about how it will be managed. Policies are considered to be nonmodifiable and non-negotiable and require changes through the established committee process. In other words, once established, no physician can write an order that is in violation of any policy. This process should remove the conflicts between professionals in specific patient situations.
And, good luck with your pursuit of the CRNI!! 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