[PICC ACE]

At my previous hospital,RN's could place arterial lines. I recently started at a different hospital,university/teaching place where the docs do them,though I have on 2 occasions "unofficially" made the stick and let them take it from there--I have a few tricks up my sleeve they don't teach in med school. Just underscores my belief that RN's should be the ones starting ALL lines in the units,but I know few others share my views on this.

[berry]

As far as painful sticks, try numbing the site with lidocaine just like an Iv start. If you are not starting them offer this up for whoever is. There is no reason for patients to just deal with the pain of being stuck. This is a position I have done a 180 degree turn on since I started using lido for IV starts. You can place a 14 gauge in somebody and they never even stop talking. Same thing with aline sticks they dont even wince.

just my $.02

[meandragonbrett]

Art line insertion is a procedure that is billable. RN's cannot bill. If RNs were allowed to do art lines, that would take away billable procedures for clinicians. I just don't see it becoming a widespread practice anytime soon.

[cardiacRN2006]

Can RT's bill?

[meandragonbrett]

Originally Posted by cardiacRN2006

Can RT's bill?

To the extent of my understanding (somebody correct me if I'm wrong here), but no the RT's cannot bill either. With RNs and RTs not being able to bill for their services, you would think hospitals would restrict a-line insertion to physicians, APNs, and PA's. Maybe i'm missing something here. Anybody else have an idea?

[cardiacRN2006]

RTs do Alines in my hospital

[platon20]

Originally Posted by PICC ACE

Just underscores my belief that RN's should be the ones starting ALL lines in the units,but I know few others share my views on this.

Dont agree. Best case scenario is an IV/line team that does NOTHING all day but float thru the hospital and draw blood, put in IVs and art lines.

An IV team that does nothing but sticks 24/7 is far better than any MD or RN who does an occassional art stick

[platon20]

Originally Posted by meandragonbrett

To the extent of my understanding (somebody correct me if I'm wrong here), but no the RT's cannot bill either. With RNs and RTs not being able to bill for their services, you would think hospitals would restrict a-line insertion to physicians, APNs, and PA's. Maybe i'm missing something here. Anybody else have an idea?

Hospitals dont see the money that doctors can bill for art lines, so from their perspective they dont really care who does it.

Art lines are actually a poorly reimbursed procedure anyways, most docs would rather use their time to do more lucrative procedures. That explains why most are content to let others do it. The only exception is teaching hospitals, in which medical residents need to learn how to do them and thus are more likely to get these sticks.

[blueheaven]

LOL I've accidently stuck arterially when inserting an IV, I always ask the doc if they want it to stay in. Where I work the interns, residents and fellows put in lines.

[PICC ACE]

"An IV team that does nothing but sticks 24/7 is far better than any MD or RN who does an occassional art stick"

This is in fact exactly what I envision. Case in point--one of my patients yesterday needed an art line. Resident,then fellow then anesthesia resident poked and jabbed and made a mess of her wrists. They agreed to let me have a shot and I showed them how I use a Doppler to do it and got right in.

Little by little vascular access has evolved over the years. Nurses took over peripheral IV placement years ago,something once viewed as an MD act. 10 years ago no one would have believed that nurses would be using ultrasound and modified Seldinger techinique for PICC's but today that is the norm. Nurses in other countries have begun to place tunnelled IJ's,Hickmans and HD catheters. I know I am totally biased,as a former IV/PICC nurse now in the ICU,but I am all for RN's expanding their practice and patient outcomes trumping reimibursement and 'tradition'.