D/C central lines in SNFs? - page 3

by nyteshade

3,891 Views | 29 Comments

Hey everyone, This is really bugging me...Can RNs D/C central lines in the SNF setting? I know it's within the scope of those that have been trained, and I've researched that not every RN can depending on what setting they... Read More


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    I have DC'd mid lines and PICCs in the patient's home, for example after a six week course of vanc at home. Lots of times. No problem. I was PICC certified at one time, but that had no bearing on my ability to remove a PICC, only to insert one.

    Just a little clarification to a previous post - CXR after placement is not only done to check the lungs, but to establish that the tip of the catheter is in the right place. PICCs, for example, can be introduced too far and end up in the atrium - not a good thing. I have never heard of a CXR post-removal.
    netglow and scoochy like this.
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    Quote from pennyaline
    Do you mean LTAC or SNF? SNFs in my area do not take admissions with central lines. The only temporary long-lines we are able to handle are PICCs. But it's my experience that central lines require CXR after insertion and after removal. If that is still the case, best to just send the resident out to have it done.
    It doesnt make any sense to get a CXR after central line removal. Whats the purpose of that? I think its a task that can be 100% handled by RNs, provided they get a little of extra training. Its really not a very difficult thing to pull a PICC or CVC.
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    Quote from nurse-lou
    It is actually part of policy that RN"s aren't allowed to remove central lines or art lines. It's a teaching hospital for doctors and they want the doctors to do it. Go figure.
    Its a stupid policy and I sincerely doubt that they are doing it so the "residents can learn it." All the residents I know hate being paged for central line removals, its not some big complicated procedure and its ridiculous that only an MD would be allowed to do it. Its clearly within the scope of ability for a regular floor RN to do.

    Central line removals are not like intubations where you need a lot of practice to get it right. I can do a 5 minute demo on it to anybody willing to learn, and unless they are an absolute fool, they will have no problems mastering it without being supervised again.
    netglow likes this.
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    P.S. Inserting a foley cath is a much more dangerous/complicated process than removing a central line, yet putting in a foley is not something that MDs are required to do. So I dont believe the rationale behind it is because its a "complicated" task.
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    Quote from platon20
    Its a stupid policy and I sincerely doubt that they are doing it so the "residents can learn it." All the residents I know hate being paged for central line removals, its not some big complicated procedure and its ridiculous that only an MD would be allowed to do it. Its clearly within the scope of ability for a regular floor RN to do.

    Central line removals are not like intubations where you need a lot of practice to get it right. I can do a 5 minute demo on it to anybody willing to learn, and unless they are an absolute fool, they will have no problems mastering it without being supervised again.
    But you guys have to do some sort of scut... we do most everything as RNs, so in a teaching hospital some stuff must be left for you to do as residents.... doesn't really matter what, gotta keep giving you reasons to continuously see/do for patients, unless you plan on being an internist.
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    As a iv certified lpn working a snf or rehab or transitional unit (name of the week)i am allowed to remove all non surgically placed iv lines, this means piccs,midlines and peripherals. At our facility cxr are done for picc insertion only, if the central line was surgically implanted then either the arnp or md has to
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    Quote from platon20
    P.S. Inserting a foley cath is a much more dangerous/complicated process than removing a central line, yet putting in a foley is not something that MDs are required to do.
    why do you think foley insertion is more dangerous and complicated?
    what's the worst that could happen?

    but pulling a cvc could be dangerous, i.e., air embolism.
    nothing of the sort will happen w/foleys...
    unless i'm having a brain freeze....again.

    leslie
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    Well, thanks everyone for your input.
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    The only time this was ever done in a SNF where I worked, the doctor came in to the facility to DC the line. They said that the resident was not moved to the hospital because the doctor did not have admitting privileges there. BTW, in a previous life, that particular doctor had been an RN.
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    We do them in PA. Now most of our IVs are Picc or midline and occasionally a peripheral. Its been a while since we've had a good old central line. I believe we have a P and P inplace too.


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