Respiratory Therapists Inserting PICC Lines - page 4

by Asystole RN

21,816 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


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    Omg. It's not totally a surprise but seriously. I am a Rn in the PICU and can speak from both sides since I still work as a RRT part time. So I know how ignorant some nurses can be the fact that a RT is a professional too. You will be surprise how many nurses can't bag mask a patient properly. And how many nurses think that albuterol is the miracle drug for every thing. And I don't fault them because clearly it's not their specialty. I'm a RT in adult acute care but working as a RN in PICU I am not familiar with some of the peds/nicu concepts. I respect my RTs. RT in some hospitals are the ones who intubate. Its a skill and clearly these RT's are capable of doing so. So placing a PICC line could be easily taught.. My sis is a PA with a 2 year degree and she was trained to placed CV lines in. And she came out of school knowing nothing. There are doctors that respect our opinion. There are also RTs that are ECMO specialists. Guess you feel they aren't qualified to do that either.
    damrcngrl95 likes this.
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    And a RN new grad at my adult hospital starts off at $22 and a recent RT new grad in my dept started $20. Hmmm
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    Respiratory therapists, at least in NC, can have a fairly extensive scope of practice depending upon their practice environment. Those of you that think that all a respiratory therapist does is twist knobs on a ventilator and suction trachs might want to read through some of the Declaratory Rulings on the North Carolina Respiratory Care Board website.
    damrcngrl95 likes this.
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    To counter the above comment, I would like to point out, that, in the military, ALL RRTs come in as enlisted. RNs, on the other hand, even when the Army and Air Force, were still commissioning RNs with RN Diplomas, and Associates Degrees, were STILL BROUGHT IN AS COMMISSIONED OFFICERS! All RNs now must have BSNs to commission, even in the Reserves, but RTs are still enlisted.
    The reason for that, is the military felt, even though both had two year Associates Degrees, Nurses have a much more stringent, higher education content than RRTs. That is why RRTs are enlisted and ALL RNs are officers.

    I have never known of RRTs to manage the IAPB. They also do not manage the Heart Lung Machines, Pump Techs do. Pump techs go to school to become Pump Techs, and they may have an RT background, but it is a specialty practice that entails attending a special school. So, no RTs do not manage the Heart Lung Machines. NURSES manage the IAPB, as well.

    I have never know of an RRT to have it in their scope of practice to place indwelling arterial lines. Anesthesia, either MDs or CRNAs, do. That is their practice, not RRTs.

    When I still worked in ICU, whenever the doctor would order a vent change, the RRT would have a COW, if I made a change to the vent, (and I would always chart it on the flow sheet).

    I was told by an RT that they wanted to make all the changes because if a nurse made the changes all the time, what they were afraid that adminstration would take away THEIR PRACTICES AND GIVE THEM TO THE NURSES BECAUSE IT IS CERTAINLY WITHIN OUR SCOPE OF PRACTICE TO MAKE MD ORDERED VENT CHANGES, BUT RRTS, CANNOT TOUCH MY CENTRAL LINES SWAN GANZ CATHETERS, IV LINES, ETC.

    Who is really afraid of another specialty encrouching on their professional practice??

    So you are trained ,"to specialize in cardiopulmonary diseases, disorders, and modalities of treatment". And lets not forget, " The sheer amount of detail we go into regarding cardiopulmonary A&P, renal physiology, gas and fluid dynamics, respiratory pharmacology, and ventilation makes most nursing students cringe.". Really??

    I have 160 college credits in nursing, which include, 8 unites in A&P, 16 units college level chemistry, 9 in Pathophysiology and Pathobiolgy, 3 in Anatomy and Kinisiology, Pharmacology, concerning the medications we are adminstering to patients and the reason why that particular drug is given.

    We certainly covered all aspects of all the major organ systems in the body, and I recall, during my A&P classes, dissecting fetal pigs. At the college where I earned my BSN, the A&P classes had human cadevers to dissect for lab.

    Inserting central lines has NEVER been in the scope of practice of RRTs. It is being MADE TO BE by Respiratory Administration. They muse feel that their profession will be taken over by RNs, in a cost saving measure, by hospitals and nursing homes because a nurses' scope of practice allows nurses to do respiratory treatments, O2 therapy, breathing treatments, etc. Nurses who work in nursing homes now do scheduled breathing treatments because nursing homes want to pay as few people as possible. RTs are expanding their scope of practice, so they will not be left out in the cold.

    I have NEVER know of a nurse, whether RN or LPN, to think that Albuterol is a special "miracle drug", and that they know nothing about. Or cannot handle other practice like bagging patients, etc. It may have been a new grad or nurse, who had little experience, but experienced nurses are well aware, of Respiratory Practices.

    It is respiratory who is afraid of losing their professional practice to RNs, and not the other way around. In years past, there were NO "INHALATION THERAPISTS" (as RTs were called back in the 60s and 70s, and NURSES did all of the breathing treatments)!

    It is a shame that RTS feel the need to validate their self worth and self importance by making emballished, inflated claims of their professional prowess, expertise, and education.

    Nurses can work independantly, start their own practices in the community, and many of them have done. RTs, cannot. It is NOT in their scope of practice. That says it all.

    JMHO and my NY $0.02.
    Lindarn,RN, BSN, CCRN (ret)
    Someplace in the PACNW












    '
    Last edit by lindarn on Aug 5, '13
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    Linda,

    Scope of practice can vary considerably by state and facility. I placed arterial lines while still a student. It is also very common for RRT's to manage IABP and ECMO once trained for the modalities, and placing indwelling arterial line is certainly within our scope of practice. At most facilities I have interned at and worked at Nurses are not allowed to place arterial lines, perform arterial puncture, or interpret blood gasses.

    We've been hearing that RN's will take over respiratory care for decades. My father heard the rumor when he was an RT starting in the late 70's, and again when he was one of the first RRTs in the country. It has never happened, and it will never happen. Nursing and Respiratory Care are two distinct fields of practice with distinct education and scope. Nursing still hasn't managed to take over respiratory care.

    You have a very interesting perspective on RRT competency and education, and it seems to be exceptionally flawed. You took nursing courses, which prepared you to be a nurse. That's excellent. You did not take courses designed for respiratory therapists which had the depth required to understand cardiopulmonary A&P or pathophysiology or ventilation like an RT did.

    The A&P course required for nursing students at the college I attended was specially designed for them, because nursing pass rates on the standard courses were too poor; it was widely regarded as having less rigor than the standard two semester A&P sequence that everyone else (including dental hygiene students) had to take. The same with nursing pharm. We had to take a general pharmacology course and a course specifically for respiratory pharmacology. More depth more rigor. I tutored many nursing students through their pharmacology with my supposedly less rigorous education.

    I've met plenty of experienced RNs who want me to give more albuterol to their fluid-overloaded CHF patients with no evidence of bronchospasm. I've met plenty of experienced RNs who push far too much fluid and cause fluid overload. I've met plenty of RNs that overbag patients with pulmonary emboli because they don't know to look for spontaneous breathing and can't assess a patient quickly to figure out whether or not they're becoming fatigued. I've met plenty of RNs who cant use an inline suction catheter correctly, much less an open suction system. I've met plenty of RNs who don't know the first thing about properly managing a chest tube.

    For every story you have about the mythical "lazy RT" I have one about the mythical "clueless nurse" that I've had to spend time with physicians cleaning up after. There are people in both professions who are not actually very good at what they do at the worst or are simply lazy at best.

    I work with nurses every day who learn new things fro me and I from them. I work with experienced nurses who are happy when I come to assess their patient and troubleshoot their chest tube or ventilator or evaluate their ability to clear secretions. Why are these nurses happy to see me instead of bodily shoving my poorly-educated incompetent self out of their patient's room? Because I'm a highly skilled professional who has been educated, trained, credentialed, and licensed to manage the airways of their patient who very much needs my services.

    I am eminently grateful that I work with nurses who are capable of recognizing that they are part of the team. I am grateful that they recognize there are limits to their education, scope, and experience. I'm grateful that they're willing to let me show them how to bag a patient appropriately and that they'll kindly "let" me manage the airway I'm licensed to manage when things go south. These nurses care about their patients and not professional siloing and breastbeating.
    damrcngrl95 and Esme12 like this.
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    Thanks for that awesome post respstudent.
    Last edit by TamTamRN-RRT on Aug 6, '13
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    As an RN who has started art line it depends on facility policy. I have worked at facilities that allow the RRT to have broad rage of responsibilities and at some that restrict their scope of practice. It all boils down to the facility and the medical director.

    As a nurse in a critical care area for 35 years.......I have worked with RRTs that I could not be without them as a member of the team. My issue with resp therapy inserting PICC lines is that they have other focus to their practice and IV therapy should not have to be one of them....they have enough to do.
    Tnbelle56, SoldierNurse22, and lindarn like this.
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    Quote from Esme12

    As a nurse in a critical care area for 35 years.......I have worked with RRTs that I could not be without them as a member of the team. My issue with resp therapy inserting PICC lines is that they have other focus to their practice and IV therapy should not have to be one of them....they have enough to do.
    I certainly agree that most RRTs have more than enough to do without having IV therapy added to their list of responsibilities; however, if it makes sense for a particular facility to train and credential an RRT to do PICC lines, I don't think it's inherently unsafe for an RRT to do that.

    My point in responding to Lindarn's post was chiefly that I disagreed with her caricature of the RRT skillset and educational process and that scope of practice varies from facility to facility for all of us.
    Esme12 likes this.
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    Quote from respstudent
    I certainly agree that most RRTs have more than enough to do without having IV therapy added to their list of responsibilities; however, if it makes sense for a particular facility to train and credential an RRT to do PICC lines, I don't think it's inherently unsafe for an RRT to do that.

    My point in responding to Lindarn's post was chiefly that I disagreed with her caricature of the RRT skillset and educational process and that scope of practice varies from facility to facility for all of us.
    I don't think it unsafe either....I would think it helpful as an adjunct......but should never precede their responsibility of intubation, Rapid Response, vents...etc
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    Quote from Esme12
    I don't think it unsafe either....I would think it helpful as an adjunct......but should never precede their responsibility of intubation, Rapid Response, vents...etc
    Oh, goodness, no! I didn't become a respiratory therapist because I wanted to insert PICC lines. I wouldn't want PICCs to be the only thing I did, but if a manager made it clear that being credential to work as part of the PICC team meant I got more shifts or wasn't furloughed as often, I would certainly give it some though.
    Esme12 likes this.


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