Respiratory Therapists Inserting PICC Lines

[Asystole RN]

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?

[tmw73]

Well I'm not sure why you think I'm condescending toward nurses but yes they covered all of what you said.the thing i was saying is that we went over those very same interventions.yes my wife went to school in florida and her mother is one of the nurse managers in cvicu.i in no way diminish your role but to diminish mine is showing that you have a lack in knowledge of what we learned.can i operate a balloon pump..yes believe me there's nothing hard about it.at my hospital we have respiratory therapist on the the ECHMO team.this is what I'm saying to you.we were taught how to do all of that but why do you think we should not? Do you think it's because we were not taught? Respiratory therapy has a strong base in critical care.in critical care that covers a wide range of things.not just breathing treatment is all I'm saying. We will soon be able to perform everything in the scope of respiratory and some of you think that's a bad thing.one person told me that they do all there weaning and vent changes but keep one therapist on staff as a consultant. Well why is that? Because if something goes wrong they have to have someone who knows what there doing without a doubt.when i said I've seen the curriculum for nursing i didn't see any extensive teaching on vents.alot of what you learned is through experience. Even in the BS program they don't cover vents to the extent we did.im sure there are things you know that i dont.NO ONE knows everything that's why you have different doctors for different aspects for patient care.i know we need each other but I'm not below you and your not below me.we are the same.if you had the attitude like your above everyone at my hospital you'd be eaten alive not just by the respiratory department but the very nurses you work with.we take a team approach and don't have time for big egos.lije I said if you want a better understanding of respiratory therapy take a good look at the curriculum. Like I said you'd be surprised at what is taught.NO ONE can do it alone...that's all I'm saying my friend. I would love to work at your hospital. I think people would view respiratory therapy a little different when you have one that knows their stuff....in the coming years change is going to happen..I appreciate the conversation. Please continue.

[tmw73]

Flying Scott.i will tell you that's exactly what I'm saying.you specialize in what you do like i specialize in what i do.we both should cross train with a duel approach. 2 heads are better than one.if we are both on the same page don't you think the outcome would benefit the patient? Like i said this is not a ******* contest. You know what you know and i know what i know.we both work together. That's how it's suppose to go.thats how it works at most hospitals. I've never worked at a hospital that treats respiratory the way some of you described. You might just have lazy therapist I'm not sure but one thing i do know is that it would never work like that here.

[tmw73]

That's exactly what's I'm saying. Just like you can learn so can we.my friend this is not a ******* contest but if you think your talking to a neb jockey.then you are sadly mistaken.i can do all of that have and have with the exclusion of dialysis. Which i can learn as well.we do have sufficient knowledge to learn what needs to be done.

[tmw73]

By the way happy nurses week..

[PMFB-RN, RN]

Well I'm not sure why you think I'm condescending toward nurses

I have no idea why you are condescending to nurses either. Here is an example:

And just in case you don't know those little knobs we turn make all the difference in the world as far as lung compliance.

yes my wife went to school in florida and her mother is one of the nurse managers in cvicu.

(chuckle, chuckle) Next time you might want to use a better example. Florida is widely recognized to be severely behind the times and not be up on EPB. Not to mention the state as a reputation of treating their nurses really badly.

I suggest you look into the more modern and up to date states and see what they are doing.

[tmw73]

Pleas explain how that's condescending? Florida isn't behind the times.those things you are talking about as far as respiratory isn't only in this state.like I told the Carolinas, Texas and Arizona to name a few are using therapist in alot of different ways.why is it so hard for you to see a respiratory therapist being able to do those things is a good thing.i see you want all the control in the world.you can't work like that.to give you a little history..Florida tried to get rid of RTS along time ago and people died as a result.that has happen in a number of states.just as someone stared before when you were in school alot of machines we use not just vents, you didn't cover until you got out of school. Well a ventilator is alot different from those machines.you can't just wing it.if you know hemodynamics any change you make on a vent can and will directly effect your co, and also may cause cardiac embarressment further impairing a compromised patient. Those are things you didn't study in school.when you say some states don't utilize RRTS do you really think they are ahead of the times? I also said the reason you are able to do all you can do and some therapist are limited is because of legislation not knowledge. The scope of practice for nursing is the oldest on the books.if you actually looked at the scope of practice it says machines dealing with patient care.it is not very specific. The same goes for respiratory. If administration wants us to do more things our license actually covers alot of it.the legislation we have in front of Congress now will extend those limits to include more including writing our own orders (with physician approval of course) but here we already utilize that.we can make our own vent changes order as many ABG'S we need even place Alines if we need them.thats because here we are proactive. All I said Is once this legislation passes it will benefit you as well.we will be able to bill more so it helps the bottom line.the way things are going they will have to make cuts to survive and if you think they won't cut nurses your sadly mistaken.money rules it all.ask some of these doctors that recently found themselves out of a job.what we do here will spread. All you have to do is read up on politics.we are not just sitting on our hands and waiting. Let me also ask if you think you can learn all those machines do you actually think we are unable to? Anyone can go to school to be a nurse if they desired.i would never question your ability I just take offense to the fact that you think that respiratory therapist can't do those same procedures especially if we actually went over those same machines. Please look at the curriculum and honestly tell me what you think..I welcome more dialog with you..I'm actually enjoying this conversation.

[tmw73]

No my friend i just used that knob thingys because that's what someone on this board said.i do not think your an idiot. Like i said before we have a good relationship with the nurse we work with here.we both have input on the patient care we both are providing. They ask me questions and suggestions as i do them.i in no way have a LACK of respect for your profession but if you think all respiratory therapist are just unable to perform those task your wrong.like i told the other guy.please actually look at the curriculum for respiratory and tell me if you think we are unable to perform those task.just like you said about knowing more respiratory than i think you do.we know more nursing than you think we do.we help each other. I couldn't work with someone who felt they knew everything. That is counter productive. Don't you think?

[tmw73]

And no my friend a ventilator is not like any other machine you use.it can have a very direct effect on just about all your vital organs.its not just decreasing rates or increasing VT'S or changing PEEP.they are hemodynamics changes that occur from even the slightest change.but you know that.

[Asystole RN]

tmw, if you were a nurse you would not be considered qualified to insert PICCs.

The only, the ONLY, reason why RTs have been adopted in a limited manner in some hospitals in some states and is purely because they represent a lower payroll cost. Thats is the only reason and the worst of reasons.

The only reason why this is possible is because the Scopes of Practice are written by exception in those certain states, "you can do it if you are trained in it, unless we say no" states.

DEMAND equal or greater pay than RNs and I will stand side-by-side with RTs who agree to undergo infusion therapy education and training prior to vascular access training. Wanting to do something because you think it is cool is just unsafe and unprofessional.

[IrishIzCPNP, MSN, RN, APRN, NP]

How is a PICC line respiratory? It is that simple for me. Will they start IVs? Why not? How about because it isn't their field. So....reps doing lines doesn't make sense to me at all.

[tmw73]

Well my friend i don't know how much you make but I in no way make minimum wage.i told you before that we make more than most nurses here.i was talking to a nurse the other day who told me she makes 45000 a year.well I make well above that.its not just a cost measure.if it was I would in no may be considered for that position. Like i said before if you feel you can touch the vents then it should go both ways.i don't know what you think they taught us but alot of those procedures you do was covered in respiratory schooling. If you can do most of what you were taught then why should we be limited in what we've been taught. In the scope for respiratory it doesn't limit us to arterial sticks.at my hospital we also start ivs. Why does this surprise you.are we not suppose to expand our knowledge? Are we suppose to sit back..and how can you say anything about things being unsafe because i do it but you would love free liberty to tough the vent . something you didn't study in school.isnt that a contradiction.

[tmw73]

And no its not that i think it's cool and i don't understand why you think i would approach this like a kid wanting your toys.its called experience. I want to all i can to learn. What's unsafe about it.