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Missie
midline orders

Hello,

We have recently started inserting midlines in our facility.  When we received our training, it was shared most facilites are not requiring a physician order to place midlines?!?! The RN trained to place midlines would detemine if the midline is apropropriate, That is determined by patient diagnosis, the treatment plan, length of time for treatment , IV medications.

Should there be a physician order for a midline or Does a facility protocol cover placing a midine per trained RNs assessment?

Thank you for your assistance

Mellissa

lynncrni
Do you have a written,

Do you have a written, approved policy for the RN to make this decision? If not, is midline insertion covered by the general admission consent? If neither, you will need one or the other to give this decision to the RN inserter. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Missie
midline protocol

Unfortunately 

No,we do not have any current protocols inplace in regards to the midline.  We are in the  process of developing the protocol when the question, do we need a specific order from the physician or can it be on the assessment of the RN. 

Thank you for your guidance Lynn.

Missie

Gina Ward
We have been doing Midlines

We have been doing Midlines for several years without a physician order.   Since it is a peripheral IV, and consent for peripheral IVs is not needed.

Then.......  our HCA division  that was working on  computer generated orders for PICC lines utlimately decided we needed to have a doctors order for a Midline too.    They said they were finding that many physicians were not aware that their patients had an advanced IV and they determined the need for a physisicans order.

Our physicians did not have issues with the RNs making that determination, in fact they were glad to let us take the lead on that and not have to be bothered with nurses calling them everytime someone needed a midline.

We have to carefully review all our patients when we recieve an order for any type of advanced line as most nurses and doctors just "check off" something in the computer that can generate an order for a PICC or Midline and that not be the appropriate device for the patient.   

 

Gina Ward R.N., VA-BC

lynncrni
The infusion/VA team should

The infusion/VA team should fill the role of consultants. The order should state a request for VA consultation, not a specific type of VAD. Team makes the full assessment and decision. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Gina Ward
I agree 100%

I agree 100%

We do  make the determination of what line is best for the pt. But, we do require an order for the specific type of line and then if our assessment doesnt agree we get in touch with the dr review our assessment and what we determined is best suited for pt then with their approval and agreement we modify the order to align with what we have decided.

Currently our orders are for  " line placement" then when the pts nurse or the MD places that order it has them select the indication ( there are 4 to pick from )  according to what they selected a specific line;   Midline or PICC line order is generated.

As i stated many times they do not select the correct indication and then we must change the order after our thorough assessment.

 

With what you are saying;    is that ok legally, professionally to just give us , the Vascular Access team RN,  the autonomy to order a PICC line ( central line) without specific permission .   I know the " order" per say is permission but......im thinking that may be above our liscence?????      I mean we do it all day every day, then we talk to DR, it requires no convincing and they always go along with what ever we say is needed but....then we enter the MD order in for the picc line...

 

look forward to your response.   

Gina Ward R.N., VA-BC

lynncrni
What you described sounds

What you described sounds fine. You are working collaboratively with other professionals to make the best decision. The legal need for an LIP to prescribe a specific VAD depends on your policy which should be influenced by the rules and regulations for the scope of practice in your state. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Gina Ward
thanks so much.

thanks so much.

Gina Ward R.N., VA-BC

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