Can RNs remove temporary (pacemaker/ epicarial) pacing wires? I am looking for:
for/against protocols or information. There have been several discussions here on this board in the past (which are informative and I will share with my patron) but I am looking for current information for my patron so I am re-visiting the question again. I am looking for information on what is being done elsewhere: your experiences/policies/protocols, etc. Especially interested in who is or is not allowed to remove temporary pacing wires and why.
Background here: We have an MD here who would like the RNs to do it but we are not sure if its in RN scope of practice. I have done the literature searching - most of its from the early 1990's-2007. It may be up to each State Board of Nursing or associations. We would like to know what is being done elsewhere and your experiences.
As always, I am appreciative of any information received.
Thank-you in advance,
I would refer to your state BON. It will indeed vary by states and scope of practice laws. In my facility, our epicardial pacing wires are removed only by a PA/NP/MD. We've had a few situations where when they were pulled the patient ended up in tamponade and required a very rushed trip to the OR for sternotomy and repair.
Thank-you for your reply. I have reached out to our State Nursing Board and they will be researching my question and sending appropriate information that will address our question about scope of practice.
Is this a BON question? I'd think it was the hospital itself. BON's don't catalogue every single skill under the sun in order to authorize nurses. That is a certifying body. If the RN is trained to do it by a competent person and is authorized by the person that placed them, why not? Tamponade occurs regardless of who pulls them out and it is the bedside nurse that is the one who needs to recognize it when it happens, not the PA/NP/or surgeon. When it does happen, the person that pulled the wires is long gone.
Depends on the hospital. I wanna say the one hospital I worked at the ICU RN could pull the pacer wires. I know the hospital Im at now an advanced practice RN can do it.
Rochester NY- RNs pull, not even ICU rns, tele floors too. Cut a stitch and pull, don't yank if you meet resistance/scar tissue formed
Jobs I've had in New England- NP/PA problem. Honestly I'd rather not tamponade somenoe, but is pulling a Cordis or femoral arterial line or anything else that we do that much less dangerous?
I'm in Australia but here we pull pacer wires on the floor. Only permitted mon-fri 7am-1pm in case the pt tamponades. We have a policy about checking vitals x times for x hours post removal and double checking INR and other labs. Most of our pts will have an echo that day anyway (routine post valve surgery at my hospital and a lot of cabg patients have them too) to ensure there's no slow tamponade. The actual procedure itself is not the problem, it's the risk of tamponade post removal. I have seen it twice but both times everyone recognised it quickly and the pts made a full recovery.
I work on a Cardiac Step Down unit and we pull pacer wires all of the time. I think it just depends if RN's are adequately trained and the hospital's policy. If we run into any resistance pulling or they have been in a long time or the patient is a risk for bleeding we will cut. Haven't had any issues so far.
At my facility RN's can remove transvenous wires but not epicardial. Personally, I feel like removing epicardial wires is too much liability for an RN. I don't want to be responsible for removing wires placed by a surgeon. What if the surgeon used faulty technique and the removal lead to an emergent situation (tampondade)? I feel like the surgeon or his PA owns that liability, not me. Just my 2 cents!