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Senate Care Bill that would restrict who uses Ultrasound

Join Us Now to Exempt Ultrasound Guidance of Vascular Access from S. 1042 – Consistency, Accuracy, Responsibility and Excellence (CARE) in Medical Imaging and Radiation Therapy Act of 2007 – Ask Members of the Senate HELP Committee to support the statements listed below:


Introduction: What is S.1042, the CARE Bill?


·         The CARE bill would require the Secretary of Health and Human Services to establish standards for certification, education, and CME, for personnel who perform medical imaging studies, including ultrasound, in all sites of service, including hospitals.


·         Physicians, nurse practitioners, and physician assistants would be exempt from these standards. All others would have to show compliance with the standards to be able to perform medical imaging studies.


·         Directs the Secretary to certify qualified non-profit organizations as approved bodies to provide accreditation or certification to individuals that demonstrate compliance with the standards.


Why Should Ultrasound Guidance of Vascular Access be exempted?

·         Vascular access nurses use ultrasound to guide the placement of a central venous catheter. Vascular access nurses are specially trained and licensed by the state where they practice; they do not need to be certified sonographers because they use ultrasound in such a narrow, targeted way. 

·         Ultrasound credentialing programs are too broad for vascular access nurses -- to require them to complete those would eliminate the ability of vascular access nurses to use ultrasound in these procedures.  

·         Ultrasound sonographers cannot place lines – not trained in the principal procedure of PICC placement, which requires significant training and specialized skill.

·         Ultrasound guidance of vascular access is a key patient safety procedure -- reduces complications such as arterial puncture and pneumothorax by as much as 78%. In a landmark study evaluating clinical practices to improve patient safety, AHRQ identified the use of ultrasound in guiding line placement as key to increasing patient safety. 

·         1.5 million PICC lines are placed by Registered Nurses per year in the United States with portable ultrasound.  Health Care Advisory Board Fact Brief (Feb. 10, 1999-001-223-738) states that the operational cost of placement of a PICC line in an Interventional Radiology Suite is $800 greater a case than at the bedside by an RN.  The overall cost loss to the United States Healthcare system should 1.5 million PICC lines revert back to radiology for placement by a physician, would be $1.2 billion dollars per year and tie up radiology suites with 28,845 hours per week. This would directly affect the availability of Interventional Radiologists to perform patient procedures with a higher acuity or urgent care need.


Take Action Today!!!


To Join Efforts to Exempt Ultrasound Guided Vascular Access Procedures from S. 1042, the CARE Bill, please take the following actions today:


·         Using the grid below, please call the staffer listed for each office and ask them to have the Senator for whom they work communicate with the Leadership of the Senate Health, Education, Pensions and Labor Committee, Senator Kennedy (D-MA) and Senator Enzi (R-WY) that prior to S. 1042 being voted on by the entire Senate, it needs to be amended to “Exempt the use of ultrasound to guide vascular access procedures.” Use the bullet points above to help make your case during the call.


·         Please follow-up your call with an email to the staffer, restating your request and rationale and ask them to respond back to you regarding the Senator’s actions on your behalf.


·         Please share this alert and information with your colleagues, asking them to complete these same actions. 


Senate Committee on Health, Education, Labor, and Pensions






Offices to Contact:









Health Staffer

Phone Number


Enzi (R-WY) - CARE Bill Sponsor

Shana Christrup


[email protected]

Alexander (R-TN)

Mary Sumpter Johnson



Burr (R-NC)

Jenny Ware


[email protected]

Isakson (R-GA)

Tyler Thompson


[email protected]

Murkowski (R-AK)

Amanda Makki


[email protected]

Hatch (R-UT)

Guy Clifton


[email protected]

Roberts (R-KS)

Jennifer Swenson


[email protected]

Allard (R-CO)

John East


[email protected]

Coburn (R-OK)

Stephanie Carlton


[email protected]





Harkin (D-IA)

Jenelle Krishnamoorthy


[email protected]

Bingaman (D-NM)

Frederick Isasi


[email protected]

Reed (D-RI)

Topher Spiro


[email protected]

Sanders (I-VT)

Abby Driscoll


[email protected]

Brown (D-OH)

Roberta Downing


[email protected]






If you have any questions or need additional information, please do not hesitate to contact ….me


Nancy Moureau

PICC Excellence, Inc

[email protected]


Thanks for the information

Thanks for the information about this. I had briefly heard about it but did not know many details. Do you know who got this bill started and why? Is this motivated by someone from the radiology world or some other specialty? Are there good parts of this bill that are necessary? Any other thoughts?


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

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

ann zonderman
Ann Zonderman, BSN, JD,

Ann Zonderman, BSN, JD, CRNI, LHRM

As all  states set  practice guidelines for medical - health care providers, this bill  seems to be overstepping state's rights.   I agree that it sounds suspiciously developed by a special interest group..  Specialty groups also direct the parameters / scope of practice.  This bill infringes on the rights of states and specialty groups to make laws to direct their citizens license parameters...

 Would love to hear how it even made it to be a bill.... please keep us updated.


Ann Zonderman, BSN, JD, CRNI

Chris Cavanaugh
I am confused, can you
I am confused, can you please clarify---when I went to, and looked up the bill, in the definitions section it says:
    `(2) MEDICAL IMAGING- The term `medical imaging' means any procedure used to visualize tissues, organs, or physiologic processes in humans for the purpose of diagnosing illness or following the progression of disease. Images may be produced utilizing ionizing radiation, radiopharmaceuticals, magnetic resonance, or ultrasound and image production may include the use of contrast media or computer processing. For purposes of this section, such term does not include routine dental diagnostic procedures
    Since we as nurses do NOT use ultrasound to perform Medical Imaging as in this definition--we do NOT use it for diagnosing illness or following the progression of disease, I do not see how this would apply to us.  We use ultrasound for the identification of vessels and to assist in accessing those vessels, not diagnosis.
    In addition, the section:
        `(2) MISCELLANEOUS PROVISIONS- The standards established under subsection (a)--
          `(A) may vary from discipline to discipline, reflecting the unique and specialized nature of the technical services provided, and shall represent expert consensus as to what constitutes excellence in practice and be appropriate to the particular scope of care involved;
          `(B) may vary in form for each of the covered disciplines; and
          `(C) may exempt individual providers from meeting certain standards based on their scope of practice.
          Seems to exempt us, as meeting certain standards based on our scope of  practice, as placing PICC lines is with in the states scope of practice.
          So, If I am off base, please clarify for me and others who, I am sure, are also confused.  
          If need be, I will be happy to write to senators to express concern request clarification in this statute. 

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Chris Cavanaugh
For those who wish, an easy

For those who wish, an easy way to find YOUR elected officials and thier contact information is via

Put in your zip code and there you go!

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

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