Respiratory Therapists Inserting PICC Lines

Specialties Infusion

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Here in Arizona several of the hospitals have started an experiment, they are actively replacing PICC nurses with RTs and calling them "Vascular Access Specialists." These RTs will place PICC lines, midlines, and US guided PIVs. My local INS chapter has not issued an official statement about this and my local AVA chapter is fully supporting this with about half of the members being RTs.

Any thoughts on this? Has anyone seen this in any other State?

Whether the order is written as 'place PICC' or 'PICC consult really makes no difference, it will get carried out the same way.

At my facility it is generally ordered as a "vascular access consult" instead of "PICC consult." The type, size, and placement of the catheter is determined by the vascular access nurse. "PICC consult" implies that a PICC was ordered.

Specializes in PICU.

I didn't get to read all the responses but just wanted to leave my 2 cents. I am also in AZ and my hospital went to RT run PICC teams about 2 years ago. It's been a difficult and bumpy two years and one that I feel affects the patients negatively. I don't know what goes on behind the scenes but I know there are a lot of internal issues (fighting, disagreements on care or practice within PICC team). Unfortunately in the meantime, patients get lost in the cracks.

I work critical care and we have always been responsible for our central lines and the maintenance of them. PICCs, dialysis catheters, Broviacs, art lines, etc. We originally had a standard day that all central line dressings were changed. This made sure that they were being done weekly. It was standard of care and rarely did lines get missed. Since switching to the PICC team, RTs come by and check dressings once a shift. They are responsible for placing PICCs and doing dressing changes on all central lines if they are soiled or due (Q 7 days). But they only do central and PICC lines. In two years, I have had only one time where an RT change the dressing without me prompting it. If we see a dressing that is curling or soiled, basically one that I would change, we call PICC team or point it out when they show up. Not once have I had someone agree with me that it needed to be changed. I'm usually told "if it gets worse, call us". As a nurse, in an ICU, I am not ok with being technically responsible for that line, yet allowing someone else to be "responsible". Many times if we call them to say a dressing looks like it needs to be changed, they can't make it. We still do change dressings but we are "supposed" to follow these guidelines and for the most part PICC team is supposed to do them. Just feels backwards.

PICC placements are a nightmare. I've had patients that have endured a 2-4 hour PICC attempt. Multiple stabs. They are bruised and marked up at the end. We have a 2 poke rule per nurse for PIVs! How in the world is a 4 hour attempt considered humane! The end result will either be no PICC or a small line that doesn't do a lot of benefit. We want PICCs so we can remove a central line. But when I'm left with a 4 french single lumen to replace a triple lumen subclavian, guess what....I can't remove that subclavian. So now we've increasing infection risk by just adding another line. We end up with single lumen lines on patients with multiple meds and drips, or lines so small you can't draw labs (which many times is the added purpose of the line). We've had to write incident reports because the dates on the dressing is different from the date on the orders. We've had them argue with us to just "go with whatever is later". The overall consensus is that there isn't an understanding of best practice or the purpose of the line. Just yesterday I had the RT refuse to place a line because she was the only one there that day and she didn't see the reason the patient needed it. It's not for her to assess. An ICU intensivist ordered it. An additional drawback is that we are supposed to hand over responsibility of these lines and yet, if the patient gets a CLABSI it is my department, not PICC or RTs that get the ding. I'm just frustrated and I would be frustrated with the care if it was RNs too.

I am very grateful for RTs and their role, and just like nurses I've met great ones and not so great ones. This isn't an RT issue, it's a program issue and a patient safety issue.

I was speaking to one of our manufacturing reps about RTs placing lines and one of the big reasons why they are being permitted to place lines in so many facilities is the fact that they can bill for RT services.

In the DRG with Medicare registered nurses cannot bill for nursing services, it is considered simply a part of the package. Outlying professions such as PT/OT, Speech, and RTs can bill outside and on-top of the DRG. Typically, this system presumes that those outlying professions would be performing services within their traditional roles.

Considering that RTs are paid less AND can bill for their services we will see them expand their roles into other areas of nursing. Vascular access is simply the vanguard of the movement, the method to test the waters.

Specializes in Oncology, Vascular Access.

Thank you, Woosha RN, for being brave enough to speak out.

Specializes in Oncology, Vascular Access.

"Considering that RTs are paid less AND can bill for their services we will see them expand their roles into other areas of nursing. Vascular access is simply the vanguard of the movement, the method to test the waters."

Asystole RN: This is not correct regarding Venous Access Device insertion. Some were billing for this, but had to stop.

"Considering that RTs are paid less AND can bill for their services we will see them expand their roles into other areas of nursing. Vascular access is simply the vanguard of the movement, the method to test the waters."

Asystole RN: This is not correct regarding Venous Access Device insertion. Some were billing for this, but had to stop.

Banner Health is a big advocate for vascular access RTs, do you know if they as a system have stopped billing? What about productivity?

I may be wrong but there are now multiple hospital systems utilizing RTs and had this conversation just last week with the rep.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Why wouldn't an RRT run a code?

What unique skill sets does nursing possess that, in the absence of a physician, only they are qualified to run a code?

Did you read any of the declaratory statements at the link I provided in an earlier post?

*** All our RRTs are ACLS too, and valuable members of the code team. But run a code? I can't imagine it. There is no reason why they couldn't but it seems outside their comfort zone, at least for the one's I have worked with.

In my hospital a variety of people run codes, usually residents, less often a PA or APN, occasionally the RRT RN. I just can't imagine our RTs stepping up to run the code.

Specializes in Oncology, Vascular Access.

Can not say more at this time, Asystole RN...I can not identify with any institution or corporation, as doing so may have an ultimate negative affect on patients.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Banner Health is a big advocate for vascular access RTs, do you know if they as a system have stopped billing? What about productivity?

I may be wrong but there are now multiple hospital systems utilizing RTs and had this conversation just last week with the rep.

I feel it has more to do with removing nurses from the bedside and utilizing alternate personnel, that get paid less, to "do the same job"....thereby increasing profit margin.

The rep.....is just there to sell their product and some will say ANYTHING to increase the sell. I know someone who sell these and while they are good at their job and know the product they know nothing about nursing, nursing education, or why on qualification is more appropriate than the next. They parrot a scripted sales pitch..they are not even a nurse.

I feel it has more to do with removing nurses from the bedside and utilizing alternate personnel, that get paid less, to "do the same job"....thereby increasing profit margin.

Yeah that is a kick in the ass for RTs. All are required to have a minimum of an Associates degree (like RNs) and most have Bachelors with a few having Masters degrees but get paid half of an RN's wage.

What some of you might not know but should find out is who is running your RT department. You might be surprised to find out RTs are now under some level of nursing management. Since RNs have taken over ABGs, puncture and iSTATs, MDIs, Nebs, EKGs, trach care and ventilator management in the subacutes, SNFs and rehabs, the nurse managers of these RT departments are looking at trying to save a couple of RT jobs amongst all the others being laid off. The other tasks were taken over by nursing because of low to nil reimbursement by CMS. RT is almost exclusively reimbursement dependent.

What's sad to me is how little new grads nurses are making. And how as a therapist my base pay is more than my Rn pay...and how physical therapist assistants make more money than new nurses

What's sad to me is how little new grads nurses are making. And how as a therapist my base pay is more than my Rn pay...and how physical therapist assistants make more money than new nurses

How little? Here in California our new grad RNs start at $45/hr. New grad RTs start at $22/hr.

PTAs also need at minimum an Associates degree and most of ours have a Bachelors working their way toward PT. Did you mean PT aides?

We also had many older RTs who had 20 years on their base pay. Due to union regs they started as a new grad when they got their RN and if they got a job. Several of our RTs did get their BSN but that was 2 years ago and still have not been hired as an RN within the same hospital or unit they worked in for over 20 years because they are new grad RNs. They can only hope to get picked up by nursing before the RT department lays off more. If not, they will be unemployed RTs and RNs. We shall seen the last of December what their fate is. Unfortunately for RTs, California is not as progressive as other states and the RTs have very little to make themselves marketable like education or PICC lines.

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