Whether it is your hospital or one that you are aware of, how many facilities are allowing nurses to perform a preliminary wet read to release the PICC for use prior to the radiologist report being issued?
My radiologists are on board with our institution creating a Standardized Procedure to allow this but, they were concerned that we not be the only hospital in California doing this. I feel confident that we would not be first but, we need your help in confirming this.
Thank you,
Tim
First you must clarify your language. No nurse can or should read any xray!! This is medical practice only as it indicates looking for pathology and a medical diagnosis. Nurses all over the country can and do assess a chest xray for catheter tip location. You will get farther faster if you do not give the impression that what you want to do is encroach on medical practice. I teach an online course on this issue and we have had nurses from all over the country take this course, but I can not refer you to anyone specifically in CA. 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
Thank you Lynn for the response. It was a pleasure meeting you at AVA.
Hopefully my question does not imply that we are seeking to replace the Radiologist. We are merely attempting to expedite the ability to release the catheter for staff use at times when a Radiologist is not immediately available to read the film. Having spoken to the majority of our Radiologists, I have received nothing but support from our group. We do currently review every x-ray for PICC placement prior to the radiologists even receiving it in the PACS system so, our current practice is similar to many other institutions around the country. We want to take it a step further and release the lines for use ASAP.
Tim
No I did not think you were trying to get rid of the radiologist role. I do not understand this need to have some formal mechanism to "release" a catheter for use that can only be done by a physician. If your written policy states where the catheter tip must be located before it can be used, and you are assessing the xray for that tip location, then my practice has always been to begin using it immediately without further delay or requiring any additional orders. We began placing PICCs by this method in 1981. 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
"then my practice has always been to begin using it immediately without further delay or requiring any additional orders. We began placing PICCs by this method in 1981. Lynn"
Based on the above statement, it sounds as if you, the nurse, has the authority to confirm a tip position and release the line for use "immediately" if you see it is at the CAJ without waiting for your Radiologist to confirm the location. Do I understand your statement correctly?
Thank you,
Tim
That is exactly what I am saying! The PICC inserter assessed tip location immediately and began infusions through the catheter if it was correctly positioned. The radiologist did the complete medical "read" of the film within 24 hours, dictated the final report. What good would it do for the nurse to assess the xray and then still have to wait on the radiologist before that catheter could be used. The main reason nurses need to make this decision is to avoid unnecessary delays in treatment. Also with the new ECG-based technology, there will be nothing for any physician to look at or decide. If the catheter tip produces the p wave changes, it is at the CAJ and can be used. 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
Hi Tim,
At my hospital in Ohio I have to wait for the radiologist's reading to release the line. I am unable to say "ok to use" until I have the official reading. I do look at all my films and sometimes discuss with radiology if I am not sure.
I am hoping for a tip locator for Christmas. :-)
Carole
Hey Tim,
Check out the P&P for the other hospital between Sacramento and you. After successful completion of the radiology in-service,
The practice was very successful and effective in reducing x ray wait times.
Anita
Thank you Anita for that tip. I was not aware "they" had that policy.
Lynn,
We appear to be saying the same thing. I am just asking for examples of other hospitals that have instituted the practice.
"What good would it do for the nurse to assess the xray and then still have to wait on the radiologist before that catheter could be used."
The reason that I always review the x-ray even though I cannot release the line for use is that more than once, a Radiologist has been wrong about where the CAJ is located. This problem has since been remedied by our chief radiologist with a bit of inservice to the affected party.
The ECG technology will quickly eliminate the need for x-rays but, until that day arrives at my hospital, I am trying to mitigate the current inefficiency of our system.
Thanks again,
Tim
Tim, I can share with you our experience and facility protocol for this, but from MN not CA. Email me at: [email protected]
Mary Deschneau RN, BSN, VA-BC