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?

[chare]

I can say no more than I have; I do not wish to reveal details out of concern for institutional privacy and reprisal.

As I mentioned in my last post you have made several statements regarding respiratory care education and scope of practice. I am not asking for either your name or the name of the facility in which you work. What I am asking for is the state in which you practice. Until you do so, your statements regarding respiratory care practice in your state lack credibility.

[Tnbelle56]

It is disturbing to me that there are so many blurred lines between these professional disciplines. But, let me pose this to you...an ob doc, a plastic surgeon, a psychiatric and an orthopedic surgeon are all physicians. All have had some similar basic training but who would you want to perform your knee replacement? Of course the orthopedic surgeon, so who would you want to insert and maintain your PICC? Who would be available to troubleshoot, administer a thrombolytic, give nurses advice, teach patients how to maintain these lines at home, etc, etc, etc?

[libran1984, ASN, RN]

There are LPNs at my hospital who place PICC lines too.

[manusko]

It is disturbing to me that there are so many blurred lines between these professional disciplines. But let me pose this to you...an ob doc, a plastic surgeon, a psychiatric and an orthopedic surgeon are all physicians. All have had some similar basic training but who would you want to perform your knee replacement? Of course the orthopedic surgeon, so who would you want to insert and maintain your PICC? Who would be available to troubleshoot, administer a thrombolytic, give nurses advice, teach patients how to maintain these lines at home, etc, etc, etc?[/quote']

PICC line training is now the equivalent of a total knee replacement? PICC line training is how long? Our ortho residents spent 5 years learning how to replace a knee.

[elprup, BSN, RN]

Wow, my eyes have been opened.

[Tnbelle56]

LOL, No, of course they are not equivalent to a total knee replacement! The point I was trying to make was that they should be done by those that can devote themselves fully to them and not by those that have their time divided into different directions such as having to keep up with RT responsibilities, etc.

[Tnbelle56]

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.

Perhaps more clearly spoken by the above poster.

[Tnbelle56]

The above quoted poster was Esme12.

[Tnbelle56]

Wow Libran! So Indiana covers this under scope of practice for them to place PICCS?

[Vascular Access RN]

I continue to be unclear, I suppose. ANy TECHNICIAN with ethics and a brain can learn to do a procedure and over repetition become successful at the procedure itself. Vascular access is more than that -- this is something no administrators recognize and only some nurses do. The RIGHT device at the RIGHT time is imperative to minimize lifetime scarring and damage. EVEN FOR SUCCESSFUL SHORT TERM IV PLACEMENT. This requires knowledge of infusate properties, catheter risk benefit ratios related to those properties, a host of underlying conditions, illnesses, co-morbidities, etc. THAT is why the RN foundational training is the appropriate one. The comment about LPNs also disturbs me.

I will concede that other disciplines may learn the task, and with an exorbitant amount of additional training, eventually be able to see the whole picture to drive the patient's insertion and care of the right device at the right time. I also believe that with the guidance and oversight of registered nursing or an L.I.P. (again, PA, NP, MD, DO, etc.) an RT can be taught to be an insertion technician. However, each case would need to be reviewed by a Vascular Access Specialist of the above mentioned appropriate disciplines for the right device.

"MunoRN" you keep assuming, which so many others do as well, that the non-specialized RN can make these determinations; or the non-specialized L.I.P. can do so. Vascular Access needs to be its own discipline. And, registered nursing is the only non "advanced" degree with adequate foundational education on overall physiological conditions, medication properties and delivery modalities, etc., prepared to be this specialized. Across the nation, healthcare is by in large doing our patients injustice with anything less.

[libran1984, ASN, RN]

Wow Libran! So Indiana covers this under scope of practice for them to place PICCS?

That would be correct. Indiana scope of practice for L's/R's is very broad and wide open. The facility is what decides most of what we can and can't do.

Ppl are always so shocked when I tell them that. What baffles me is why so many places would consider an L's knowledge of PICC lines so much less than an R's? I don't know any school that trains a nurse to insert PICC lines. This is on the job training! An L, an R, or even an RRT/CRT can place the PICC with proper training (and within state scope of practice)

[Vascular Access RN]

This IS practice at the many facilities in AZ where RTs place and maintain lines. The RTs first aspirate every device when they check patency (during routine maintenance or troubleshooting after insertion). They have to, as intravenous medication delivery is outside their scope of practice. It is believed (by those in charge) that this gets them around scope of practice violations.