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Robin Wanous-Wi...
Reading PICC xrays
Is it within scope of practice in Minnesota for a CRNA to read a PICC xray?  Had a situation where the CRNA inserted the PICC and then reviewed the xray and wrote "okay to use".  Long term care facility nurse questioned this because "okay to use" didn't reassure her that the PICC was in the correct location.  She contacted the facility where the PICC was placed and was told this was all they had until the radiologist could read the xray on Monday.  Just wondering if this okay within the regs for state of MN.  Thanks.
Glenda Dennis
I don't know what the scope
I don't know what the scope of practice in Minnesota is but I believe that the order "OK to use" is only good if accompanied by a statement of where the tip of the catheter is located.  That said, the medical community in my state of Oregon, generally does not include that statement.  When I am taking an order to use a CVAD, I ask for that information and write it in the order with the hope that I can change practice habits in my small corner of the world.  PICC nurses may read their PICC x-rays in Oregon with a radiologist overread later.  I always chart the PICC tip location with a "OK to use statement".
lynncrni
Any statement such as "OK to

Any statement such as "OK to use", "Line in good position" etc is never sufficient unless it is accompanied by anatomical descriptors of exactly where that tip is located. I am not familiar with the rules in MN, if they are a decision tree state or must make declaratory rulings on scope issues. But regardless of who wrote that order, it is insufficient for any primary care nurse. Before infusion begins, the nurse must know the anatomical location of the catheter tip and that it is in the lower portion of the SVC. I do not place must emphasis on having a specific order about the line being ok to use, but each nurse must know the tip location before use. Lynn 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Gwen Irwin
When we have to have the

When we have to have the radiologist review chest x-rays, we don't accept OK to use.  We bug them to tell us where the tip is.  Since we are looking at most of the chest x-rays ourselves, we don't have many to get the radiologists to look for the tip location.

I agree that OK to use is not really acceptable.  It needs to identify the tip location.

Gwen Irwin

Austin, Texas

Rhonda Wojtas
We had this exact subject

We had this exact subject come up today. The radiologist reading was "PICC line and NGT seen in good placement." We called and had them do and addendum to the reading for exact placement. Our issue is that the radiologist will  state the postion but not state "Ok for use".  The nurses want the placement as well as a statemnet okay for use.The radiologists say they didn't place the line so they can't say okay for use. They don't know if the port is clogged etc. So after we get the placement we have been going back and writing in the progress note the placement as verified by radiology and that the PICC line in okay to use.

 I agree you need exact placement of catheter.

 Does any one else have the issue with staff wanting the "okay for use" statement?

Rhonda Wojtas, RN VA-BC

lynncrni
Actually I see no need for

Actually I see no need for any order stating any line is "OK to use." What purpose does it serve? All nurses need to know the exact anatomical location of all catheters before they begin infusion through them. They need to know if the stated anatomical location is the proper place. If it is not, they should withhold infusion through that line until it is shown to be in the proper location or consultation with expert vascular access nurses and the patients physician has determined that the risk of the tip location does not outweigh the benefits of the location. This involves assessment of the types and characteristics of the therapy, the length of therapy and the alternatives to line placement. This "OK to use" order is either redundant or the nurses are not understanding that they are accepting the legal responsibility for infusion through that line and this order will not absolve them of that accountability for the outcome. In other words, I have seen numerous physicians state that a line was ok to use when it was grossly malpositioned. If the nurses had used that line and a serious complication developed, that physician's order would not have preventing the nurses from being responsible. Lynn

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

irene chris
our medical director has

our medical director has added to our protocol, if the "radiologist reads the picc in the superior vena cava", we have his permission to write a verbal  order ok to use.  All other placements have to be called to the ordering physcian for an ok to use order. Our rads will never ok to use, but they do specify the tip location.  Hope this helps. 

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