Ok, so I ran across something new tonight in a post-code pt I was trying to get to CCU, thought I'd get input from other facilities. Long story short: older male, cardiopulmonary arrest, CPR in progress upon arrival, arrives with 18 g in LAC. In the whole crazy mess that is a code, I put an 18g in his foot and an 18g in his EJ. Got a pulse back, stabilized him, put him on Dopamine. Our CCU is notorious (well let's face it.. any CCU) for being hard to deal with and they enjoy finding any reason to not take a patient. So my CCU patients are always stylin' and profilin' (WOO! /Ric Flair). This guy has 18g IV site x 3, criticore foley, 18 fr OG, all clothing removed, all IV tubing orderly, pressures charted q 5 min, yada yada yada.
So I call report and I get about 5 sentences in to report when I get, in a very angry tone: "That patient can't come up here, he's on pressors and he doesn't have a central line. It's hospital protocol."
Alright, I work 6 days a week and take care of CCU patients on a regular basis. I've never heard of this "protocol" and have never had this issue with a patient on pressors before. Any time I have a pt on pressors, they always have 3 IV sites, code or not. So my question for the great minds of AN.com is this: do any of your facilities have this protocol? Granted, in a perfect world, a patient on pressors will have a central line. We don't always operate in that perfect world though. I assumed 18g x 3 is a very reasonable negotiation with that perfect world, but what do I know?
Also, a further question: does anyone in your facility other than the ER docs do central lines? We proposed that the hospitalist, who is an internal medicine doc, put the central line in when he sees the pt in CCU. No dice. "I don't do central lines." Any time someone in the hospital needs a central line, the ER gets called. I guess I halfway want to vent as well, because we get so much flak for "doing nothing." Grrrrrrr.
Anyway, input on this whole central line protocol would be much appreciated. Just curious to see how other facilities operate. Thanks guys and gals.
No, we don't have this protocol. If there is time in the ED to place a central line, one of our ED docs will do it. If not, it has to be done in the ICU by the intensivist. "I don't do central lines" is not an acceptable phrase for an intensivist or an ED doc in our facility to utter. If you do not do central lines, then you have no business taking care of critical patients. Period. But, as mentioned above, you need to find out if your facility really has this policy.
Last edit by Anna Flaxis on Aug 28, '12