I would like to throw a question to the forum. How do you all feel about placing lines in pediatric patients if you are not specialized in Peds. If an institution is large enough to have a pediatric ED, and pediatric hospital,....is it wise to allow adult PICC team place those lines. And Lynn, please answer because I'm really interested in your thoughts as well.
Jack
I definitely think it is extremely approrpiate for infusion/VA nurses to do PICC insertion on peds. Our specialty is not diviided by age. CRNI exam for all includes special populations like neonates, and peds. Anatomy and physiology is the same, just smaller. The big difference is the growth and development stages and how you approach each one. ALL infusion textbooks include this information in the peds chapter, not rocket science to learn. I vote a strong yes for our specialty to do all ages.
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
Ok..follow up. If a hospital has it's own Pediatric hospital, Pediatric ED, and those nurses do not cross between. What makes up able to do this on a 35 day old infant?....Lynn, legally, there is no liability dippng your toe into the most litigious population? Your right ,veins are veins...but you must admit an inant may have anatomy situations that we as adult nurses are not comfortable with.
Highest risk population receiving insertion from the professional with the highest level of skill is most appropriate. Your knowledge of pediatric diagnoses will need to improve, along with fluid and electrolyte and pharmacology for this age group, but that is doable. Either your team should service peds or there should be a special infusion/VA peds team, but it should not be turned over to the peds staff nurses. They are equally as overburdened as any adult med-surg nurse. Maybe your facility should look at those peds hospitals that have peds infusion/VA teams as there are many - Jacksonville, Cincinnati, Boston, Atlanta are just a few that come to mind quickly. There will always be risk with any patient population. Individual and facility liability for a negative outcome depends on the facts of each case, and which side has the strongest experts, and which experts are most believable by the jury if it goes that far, but most cases settle long before trial. Follow evidence-based practice and meeting the standard of care which is informed by a variety of standards and guidelines documents. But no one can guess or determine in any way the outcome of a lawsuit as there are so many varibles to consider.
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
Ok, thanks Lynn
I would agree with Lynn's reply. If your vascular access specialists cross over to both hospitals, then the RNs who place PICCs should complete some type of learning modlues to insert PICCs in children, but the insertion procedure is very similiar to that in adults. If the VAS team does not cross over between adults and peds, there should be a neonatal/pediatric VAS team. Neonatal PICC insertion is an additional skill set, but again, there are very good resources out there from NANN, PICC excellence, etc. The differences woudl be site choices and anatomy, sedation considerations, PICC sizes and tip location, At CHOP, we insert PICCs in neonates as small as 600 grams on up to adult patients. Even though we are a pediatric institution, we still get adult patients with congenital defects that necessitate pediatric specialist follow up. I would recommend VAS teams having capability to do all ages if applicable to the layout and population of the agency.
Anne Marie Frey RN, BSN, CRNI, VA-BC Clinical Expert Vascular Access Service: I.V. Team The Children's Hospital of Philadelphia [email protected]