Respiratory Therapists Inserting PICC Lines

Specialties Infusion

Published

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?

Ok I'll say it this way to be more technical for you..Joint Commission decertifies you..you get no medicare dollars for being non compliant..other hospitals follow suit..now unless your Mayo or some other privately owned hospital that doesn't use any government funds then no it won't bother you but how many of those hospitals exist.i know only 2 that fall into this arena.

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Specializes in HH, Peds, Rehab, Clinical.

Tmw73, I find it a little odd that you keep addressing the NURSES here as "my friend" when I highly doubt anyone still responding to you would ever have the same feelings of affection towards you...

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To sit there and say it is alright for RT'S to insert PICC lines because it is a trainable skill is akin to saying you don't need nurses you can train anyone in the hospital to do it. I like to think my RN training sets me apart from other professions in the hospital and I didn't blow it and should have just chosen to be and RT because essentially the housekeeper could do my job if trained to do it correctly.

We have IV teams in our hospital available 24/7 but that being said, I don't recall them inserting PICCS outside of day shift because at least on the med/surg floors, it could wait for a couple hours. I also would have to admit, as a patient, I wouldn't allow an RT to place a PICC for my self or family member because I don't believe it falls under their scope of practice just because they can bill for it.

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Well first it's just a saying.i address everyone as my friend and if me just making my opinions make you that upset then I don't know what to tell you.like I told you when I was in school we studied insertion of PICC lines just like we studied inserting Alines.we also place IV's. Believe it or not it is covered under our scope of practice.giving rescue drugs..I've used alot of them in IO's and IV'S. I've push alot of them straight down ET Tubes.ive been on the transport team where the line between nurse and respiratory therapist has no limits.ive worked withnurse's who have intubate when I put in lines and pushed Epi or vasopressin. We work together.have you ever been on a transport team? I'm guessing not.in those situations Noone cares who's done what as long as it's done..and to compare respiratory to housekeeping let's me know that you have no idea what's taught in respiratory. As far as scope of practice it also depends on what your facility will allow you to do.our hospital medical director is a pulmonologist who is very pro respiratory that's why we can do most things we do.just about all the hospitals are headed by pulmonologist who are the head of critical care. We have a duel role with Peds and adults.Our hospital has had numerous awards as well even ranking as one of the top hospitals in the nation..i agree your RN license does set you apart that's the same way I feel but don't tell me you are above me because like I've said I've seen what's taught in nursing school.now answer this for me have you seen what's taught in respiratory? It's called Cardiopulmonary for a reason.it doesn't say breathing treatment expect or knob turner.Critical is the base of Cardiopulmonary. .All critical care which includes vascular Access. Swans, CVPs balloon pumps and even empellas.so I'm not speaking out the side of my mouth.you can easily look at the curriculum for respiratory if you think I'm fabricating anything to what's taught.

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Specializes in Critical Care, Emergency, Education, Informatics.

You have the luxury of being in a place that has 24/7 IV team access and what sounds like an active PICC program. In your environment, it prob wouldn't be effective.

In other locations thought, pt's needing PICC's have to be transported to other hospitals 30 min to an hour away. With current reimbursement criteria, hospitals aren't reimbursed for an RN inserting a PICC on an inpatient. Economically having providers or in some places having RRT do it, is the only way it's going to happen in their facility.

Not claiming it is the best choice, but it may be the only choice in some facilities. When I set up the PICC program here, we had to have full reimbursement in order for it to happen. In our case we sent the providers to school to learn how to put them in. Although RN's can use the ultrasound for PIV access (under specific guidelines) we don't put in PICC's even though there are 2 of us that have been putting them in for years.

The reality is in smaller facilities, the only way things are going to happen is if they can bill for it. If you can't be reimbursed, it's not going to happen. The hospital would go out of business.

Same reason I'm not allowed to intubate on the floor, even though I've got more experience than any to the providers. I do in the ED because it's different set of rules.

Now if someone would start their own PICC company in SW GA, I'm thinking there is enough business to make a go at it. If I could swing $20k for an ultrasound I'd do it.

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I wasn't comparing you to housekeeping but let's face it, you seem to believe that RN's are below you and are no better then trained monkeys. Your arguments have basically implied that you could do everything a nurse could do but nurses could never do your job due to what you learned in school. I have received education on vents, I am also ACLS, and PALS certified. I manage airways everyday in my job. I believe in all your arguments that you were belittling the nursing profession and yes it is my opinion that I don't believe a respiratory therapist should be inserting PICC lines and ALINES. And no, if it were myself or a family I would not allow an RT to insert a PICC LINE or ALINE on my family. Even the nurses in my facility do not insert ALINES.

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Specializes in Critical Care, Emergency, Education, Informatics.

On an educational/discussion note it's interesting that different boards have chosen to interpret things differently.

The FL society of Resp therapy is on record for interpreting the ASA (American Society of Anesthesiology) paper on anesthesia and sedation by non anesthesia as permission for RRT's to give. The exact same paper is what BON's are using to say that nurses can't perform procedural sedation and can't give certain medications.

As nurses it's up to us to educate our BON's on the reality of things. Our scope of practice is being limited by nurses, not anyone else in a lot of cases.

The respiratory therapy in all health care setting receiving CMS money isn't actually a law, it's a policy statement by the Resp therapy association. A good goal, but not realistic. The definition of RRT's being present is open to interpretation. Drive down I-70 or I-80 across the midwest and a lot of those critical access hospital you'll pass will have a RRT as a consultant or part time. Only there a couple of days a week.

p.s. snarky comment alert. I wrote this on my phone and I managed to put paragraphs and punctuation in it. :)

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No I never said nurses were beneath us I've always stated we are equals.your right we would never be consultants here.were not going anywhere. The hospitals her wouldn't allow that.ive never heard of that but I don't doubt what your saying cause I don't live there.i only know what's going on here and the other states I've visited. I've said in every statement I've made that we are equals.you believe a monkey can do respiratory and that's where your wrong.here we have a strong society and if you look at the policies were trying to implement through congress it will strengthen nation wide.

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Specializes in Critical Care, Emergency, Education, Informatics.

Not so much belittling but hyper inflating a role. When that happens, most us pretty much stop listening. When ever ego's get involved it gets interesting.

When you actually take the time to read the posts, it's usually pretty easy to tell the real from the made up. The medicine comes out of a textbook and not the reality we know. As soon as they start to make blanket, THIS IS THE WAY IT IS kind of statements, it's an indication that they are looking for get under your skin and get a reaction. It's especially entertaining when a few min of google can prove them right or wrong.

There are a lot of things that are "allowed" under scope of practice, but not done. My current scope of practice "allows" me to but in central lines, but the reality it, it's not in the best interest of the patient for me to do it. I don't do enough of them and the risk far out ways the benefit.

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Also i have PALS, ACLS, and NRP.those are certificates that we all can do...i guess I need a phone like yours.i get tired of going back a forth fixing some of these words so I don't. I guess it needs english lessons.

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I agree with you that's why I got on this board because I wonder if this was standard practice or just something they were trying at my hospital.when I asked the question that's when all this BS started about Respiratory being to dumb to do it..All you have to do is read the scope of practice and people interprete them the way they want.in the scope of practice for nurses here it does not specify what machines can be used but that they can operate them.they give you a book a check off then send you on your way..that's very dangerous. .it never specifies vent, balloon pump etc.its all in how administration sees it..I'm sure if your therapist just sit on their asses then that's why you feel the way you do but there are alot out there that are more involved than what your use to.in those states they allow them to be what they can be.i just so happen to live in one of those states. .

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If you had read my comment, I said that your previous comments implied that monkeys could do the jobs of nurses. If you go back and look at your comments you appear to have a lack of respect for nurses while being proud of your own profession. You have implied that anyone can do what nurses do so why can't it be the other way around?

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