Respiratory Therapists Inserting PICC Lines - page 2

by Asystole RN 24,200 Views | 217 Comments

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.... Read More


  1. 1
    great transcript of your discussion. i'm glad i ran across it. both of you bring up some very good points.
    i have had the opportunity to work with some very good techs in an i.r. setting. they were/are very strong professionally, however, techs are not trained to deal with a lot of the intricacies that surround really sick people getting piccs.
    to be fair, nurses that are placing piccs have usually worked in the trenches so to speak and are intimately familiar with seeing patients as a whole. what i mean by that is you can see a patient's info (age, diagnosis, medical history, medications, labs, current overall condition, body habitus, etc.) and you immediately know how all of these things are going to interplay with a line placement.
    on one occasion, i was going to help with staffing in an i.r. and with placing piccs in a hospital that was affiliated with the hospital i work at. the tech placed the piccs at this hospital.
    we grabbed the cart and ultrasound, etc and went to the icu to place a picc. i was just helping out opening things on the sterile field, etc. and tech placed the picc. super nice guy, but after watching that picc placement, i was like, no way.
    the short story is that it's more than just a procedure or act. i walked away from that assignment.
    i understand that hospitals need coverage etc. all things being equal, i'll take the nurse.
    "in the end, picc placement is a task, one that hardly encompasses the wide breadth of skills and knowledge that defines nursing, so i don't see it as a huge blow to nursing to lose something that really best falls under the role of a "tech"."
    like i said, great discussion, but this particular point made by munrorn above is completely contrary to my experience assessing for and placing piccs.
    i have noticed similar trends in working in/around unionized hospitals and could not agree with you more.
    Last edit by mandomania on Aug 7, '12 : Reason: clarify point.
    lindarn likes this.
  2. 1
    Quote from 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?
    I am reading what is being said about RN's and RT's placing PICCs. I actually own an IV Team in the state of Washington and have about 20 RN's servicing facilities needing IV lines placed 24/7 throughout a major part of Washington. Although we are a busy team, our turn around time for services are normally able to be provided within 2 to 4 hours of receiving the call. Our services expand beyond the placing of lines to include troubleshooting lines over the phone as concerns come up and providing educational programs for placement, care and maintenance. Although I know RT's can be trained to place PICC lines, to me it doesn't necessarily mean they should be placing them. RT's have a real expertise in their field but it doesn't necessarily mean they have the educational background that an RN has. If I was going to be getting a PICC placed in me or a family member my choice would not be to have an RT place it, just like it would not be my choice to have an RN feel they know everything they need to know about providing RT services. I know RT's are being brought into the field of placing PICC lines in the state of Washington and other states. I know, administrators are using the excuses of not being able to get coverage provided by RN's because they don't want to work after hours, but this is primarily a cope out. Nurses go into the health care field knowing they will be working nights and week-ends and holidays. It is cost related and I know this because I have spoken to administrators about the reasons for the changes and that is the main reason I have been given. Our team is always open for expanding and I have nurses willing to take those calls 24/7.
    lindarn likes this.
  3. 1
    Another excuse to steal the professional practice of RNs. And RTs were probabley thrilled to have another skill to advance their profession. Are they billing for their services? While an RN is probably doing it as part of the room rate?

    And I am going to assume, that the Washington State Board of Nursing, was all too happy to sell our professional practice to someone else.

    RTs placing PICC lines? What am I missing?

    JMHO and my NY $0.02.
    Lindarn, RN, BSN, CCRN
    Somewhere in the PACNW
    SoldierNurse22 likes this.
  4. 1
    Since when it in the scope of practice of an RT to place central lines, etc?

    They are waiting for a response from the nursing community. Nursings' silence is an approval for the State and Hospital Association to steal more of nursings' professional practice.

    You nurses in Arizona should have jumped on this the minute it was proposed. If you let this go, it will snowball, until there will be NO justification for having nurses at ALL. What does it take for nurses to act?

    If you are afraid for your jobs, it it time to call the National Nurses United, and get the ball rolling for a union organization campaign. What more are you/we, willing to give up? We have already allowed nurses aides to administer medications in nursing homes an ALFs. Now we are allowing RTs to place Central Lines. PTs and Ots are doing our dressing changes. What is left for us to do under our professional scope of practice?

    JMHO and my NY $0.02.
    Lindarn, RN, BSN, CCRN
    Somewhere in the PACNW
    geegee12 likes this.
  5. 2
    I contacted both the INS chapter in Washington and also the State Health Dept for RT's. The representative of INS stated they knew there were a couple of states where the RT's are starting to be trained and placing PICCs. I was told unless nurses stand together and put a stop to it, that RT's will get a foot hold into the vasular area and it will be very difficult to stop it. I was told INS has brought it up during one of their conferences but it has not been address agressively. While talking to the State Health Dept for RT's, which I believe is being ran by RT's, I was read what the scope of the RT consists of, which includes the approval to access a vein. When I stated there is a big difference between accessing a vein and placing a PICC I was informed the scope of practice in this area is written very vague, therefore it can be interpreted however an organization wishes it to be interpreted. Therefore if a facility wants to have their RT's place PICC's there is nothing within the scope of the RT's that prevents them from taking on the task.

    I was talking to an RT that places PICCs within a hospital and is now training other RT's to also place PICCs within their facility. I was told about the training that was being done and when I asked about the success rate of placing the lines I was told it was pretty good. During the discussion, I became very aware of the vast amount of holes within the training and the lack of monitoring of quality assurance. An example of this was, the person I was talking to, that had gone to the supposedly extensive training didn't even realize there is a limit on the amount of times you should attempt a line placement if you are having difficulty getting in. Which means, if you have no limits to the amount of times you poke, you will more then likely evently get in.

    It reminds me of a dangerous intersection that has no stop signs. Until there is a death related to an accident and a law suit is filed, there will not be a stop light put in to help prevent a serious accident from occuring. Nurses are suppose to be advocates for their patients. How is this within their patients best interest. What gets me is that much of the administers within hospitals are run by physicians and nurses. This is where the almighty buck becomes more important than the health and welfare of the patient. I do not believe it is all about nurses not wanting to work nights. Whats sad is most nurses don't even know this is occuring.

    So, what do we do to change things and bring it to nurses attention!!
    SoldierNurse22 and lindarn like this.
  6. 2
    We need to go public with this, so the general public can have their say as well.

    RTs have a two year associates degree as entry into practice. Yes, RNs also have that option. HOWEVER, the education levels ARE NOT THE SAME! Not to mention, that the BSN is becoming only what hospitals are going to hire.

    I would compare the two in a letter to the editor, and include that the military, until recently, allowed Diploma and Associated Degree nurses to be commissioned in the reserves and active duty.

    NOW, only BSNs can commision in active duty and the reserves. Respiratory Therapy, X-Ray Techs, can only enter the military as enlisted. It has always been that way. That is because the military recognizes the differences in professinalism in and four year college degree, and a technical two year associates degree.

    We need to compare this to the public, as well as, it is a skill that nurses can and do, use to open a business, and market it to the public, Nursing Homes, Assisted Living Facities, and this is now being taken away from us. No one takes away, or suggests, that PTA, take over the practices of PTs or OTs, by PTA, and allow PTAs to open a business to do that. From what I have read previously, RNs doing PICC line placements have a lucrative business.

    An RNs professional practice is being slowly but surely taken away, and given to other individuals and departments. First in was nursing homes allowing LPNs to be the only licensed individual at all times, medicatation administration given to medication tech, or aides. PTs and OTs now doing dressing changes, that is a skill that is not taught in their schools, unless it is something that is being taught now to take it away from nurses. Nursing does not bill for their services in the hospital. RTs do. That means, if a staff nurse does a dressing change, or places a PICC line, her skill is included in the room rate. If the RT does it, they will bill for it. Hence, revenue for the hospital. Nursing is once again being placed in the negative column of the balance sheet. The hospitals DO not want nurses to bill for their services, as that would as value to our profession. They want us on the negative side of the balance sheet.

    Where is it going to end? With the removing of nurses from practice altogether. We will go the way of elevator operators, replaced by technnology, or HS dropouts. That, in my opinion, is the ultimate goal of hospitals and nursing homes. When our professional practice is being given to anyone who wants it, what will be left for nurses to do? Act as Chief Cook and Bottle Washer for the unit? Nothing more than a fugurehead?

    Can anyone even argue that it is what is happening slowly but surely. School nurses being replaced by the School sectretary and the janitor?

    WAKE UP NURSES!!

    JMHO and my NY $0.02.
    Lindarn, RN, BSN, CCRN
    Somewhere in the PACNW
    Last edit by lindarn on Sep 29, '12
    SoldierNurse22 and tyvin like this.
  7. 2
    I could not agree with you more. It would be nice to have more nurses involved in this topic.
    SoldierNurse22 and lindarn like this.
  8. 0
    In addition to my above comments, WHY are the positions of PICC nurse not being offered to other nurses in the facility? Why is the knee jerk reaction to give a nursing department/position to another department?

    I find it hard to believe that there are not other nurses in the hospital who would jump at the chance to become a PICC line nurse. This is a marketable skill that a nurse can use to start his/her own business, and become a successful entrepeuner. Or has the option not even been enertained by the hospital, who is more than happy to take another skill from the department of nursing?

    JMHO and my NY $0.02.

    Lindarn, RN, BSN, CCRN
    Somewhere in the PACNW
  9. 0
    Just to clarify on the SOPs.

    In Arizona we have rather lose SOPs for all the healthcare professions. Most of the SOPs are defined by the comment "what the professional is educated in and trained for" which leaves a lot of room for interpretation. This here is the root of the problem, open ended SOPs.
  10. 0
    Lindarn,

    From what i understand our association (AARC/NBRC) is heading in a direction that will require all RRT's to have a four year degree in 2015. This will have the effect of our profession to be more inline with RN's also requiring a four year degree as well. Hope this helps.


    2015 and Beyond Conferences | AARC.org
    Last edit by RRT_IN_2013 on Oct 7, '12 : Reason: color code removal


Top