Respiratory Therapists Inserting PICC Lines - page 9

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,... Read More

  1. Visit  Vascular Access RN profile page
    1
    PMFB-RN: This is us too. Except that our Admin won't give us enough staff for nights.
    Quote from PMFB-RN
    I am shocked at the variability of practice out there when it comes to PICC lines. In my hospital only trained RN place PICCs. They can place PICCs without a physicians order. When a physician do "order" a PICC it is entered as a PICC consult. The PICC RN assess the patient's need for access and their suitability as a PICC candidate and decide of the patient would benefit from a PICC vs a mid line or simply using the ultrasound to place a couple of IVs. They a order lab tests like coags o CBC to determine a patient's suitability for a PICC.
    We have 24/7 PICC coverage (PICCs are collateral duties). I am shocked that any management would allow their PICC RN jobs to become a 8 hour day shift gig.
    lindarn likes this.
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  3. Visit  Esme12 profile page
    1
    Quote from libran1984
    Does not mean they are not out there. I never knew of any either until last year either. It is very nice to know someone can actually cite Indiana practice. It has been a huge uphill battle to convince governing bodies that LPNs can do so much more than they allow, given the chance.

    PS- I absolutely love LOVE your doggy pictures. They have filled me with so much joy over the last year or two!
    I love my baby..she is such a ham...William Wegman isn't a genius .....he just loves weimarners....LOL

    I went to school in Indiana....Purdue grad here....lived there for a long time. Indiana has one of the more liberal nurse practice acts for LPN's that I have seen. I was stunned when I moved to New England and found out that they were essentially removed from acute care all together and had an extremely limited practice.

    I think there is selfish motive in the nurse practice acts. They are set by RN's and advanced degree RN's. LPN's really do not have real representation. This is that push for higher education at the bedside...that club of exclusivity.... which will ultimately be our doom.
    lindarn likes this.
  4. Visit  MunoRN profile page
    1
    Whether the order is written as 'place PICC' or 'PICC consult really makes no difference, it will get carried out the same way.

    Just like everything else we do (and everything RT does) the appropriateness of all potential interventions will be evaluated based on their appropriateness related to the indication, and contraindications will be ruled out. It would be one thing if this basic premise was not already a basic component of RT practice just as it is in Nursing practice.

    If the indication is "difficult IV start", it really makes no difference if the practitioner is an RN or RT, unless you think that trying an US guided peripheral IV first is out of the comprehension abilities of an RT.
    lindarn likes this.
  5. Visit  PMFB-RN profile page
    2
    Quote from MunoRN
    Whether the order is written as 'place PICC' or 'PICC consult really makes no difference, it will get carried out the same way.
    *** We changed it from order to consult because some of the doctors thought that since they ordered it we had to place it
    Vascular Access RN and lindarn like this.
  6. Visit  Asystole RN profile page
    3
    Quote from MunoRN
    Whether the order is written as 'place PICC' or 'PICC consult really makes no difference, it will get carried out the same way.
    At my facility it is generally ordered as a "vascular access consult" instead of "PICC consult." The type, size, and placement of the catheter is determined by the vascular access nurse. "PICC consult" implies that a PICC was ordered.
  7. Visit  WoosahRN profile page
    2
    I didn't get to read all the responses but just wanted to leave my 2 cents. I am also in AZ and my hospital went to RT run PICC teams about 2 years ago. It's been a difficult and bumpy two years and one that I feel affects the patients negatively. I don't know what goes on behind the scenes but I know there are a lot of internal issues (fighting, disagreements on care or practice within PICC team). Unfortunately in the meantime, patients get lost in the cracks.

    I work critical care and we have always been responsible for our central lines and the maintenance of them. PICCs, dialysis catheters, Broviacs, art lines, etc. We originally had a standard day that all central line dressings were changed. This made sure that they were being done weekly. It was standard of care and rarely did lines get missed. Since switching to the PICC team, RTs come by and check dressings once a shift. They are responsible for placing PICCs and doing dressing changes on all central lines if they are soiled or due (Q 7 days). But they only do central and PICC lines. In two years, I have had only one time where an RT change the dressing without me prompting it. If we see a dressing that is curling or soiled, basically one that I would change, we call PICC team or point it out when they show up. Not once have I had someone agree with me that it needed to be changed. I'm usually told "if it gets worse, call us". As a nurse, in an ICU, I am not ok with being technically responsible for that line, yet allowing someone else to be "responsible". Many times if we call them to say a dressing looks like it needs to be changed, they can't make it. We still do change dressings but we are "supposed" to follow these guidelines and for the most part PICC team is supposed to do them. Just feels backwards.

    PICC placements are a nightmare. I've had patients that have endured a 2-4 hour PICC attempt. Multiple stabs. They are bruised and marked up at the end. We have a 2 poke rule per nurse for PIVs! How in the world is a 4 hour attempt considered humane! The end result will either be no PICC or a small line that doesn't do a lot of benefit. We want PICCs so we can remove a central line. But when I'm left with a 4 french single lumen to replace a triple lumen subclavian, guess what....I can't remove that subclavian. So now we've increasing infection risk by just adding another line. We end up with single lumen lines on patients with multiple meds and drips, or lines so small you can't draw labs (which many times is the added purpose of the line). We've had to write incident reports because the dates on the dressing is different from the date on the orders. We've had them argue with us to just "go with whatever is later". The overall consensus is that there isn't an understanding of best practice or the purpose of the line. Just yesterday I had the RT refuse to place a line because she was the only one there that day and she didn't see the reason the patient needed it. It's not for her to assess. An ICU intensivist ordered it. An additional drawback is that we are supposed to hand over responsibility of these lines and yet, if the patient gets a CLABSI it is my department, not PICC or RTs that get the ding. I'm just frustrated and I would be frustrated with the care if it was RNs too.

    I am very grateful for RTs and their role, and just like nurses I've met great ones and not so great ones. This isn't an RT issue, it's a program issue and a patient safety issue.
  8. Visit  Asystole RN profile page
    0
    I was speaking to one of our manufacturing reps about RTs placing lines and one of the big reasons why they are being permitted to place lines in so many facilities is the fact that they can bill for RT services.

    In the DRG with Medicare registered nurses cannot bill for nursing services, it is considered simply a part of the package. Outlying professions such as PT/OT, Speech, and RTs can bill outside and on-top of the DRG. Typically, this system presumes that those outlying professions would be performing services within their traditional roles.

    Considering that RTs are paid less AND can bill for their services we will see them expand their roles into other areas of nursing. Vascular access is simply the vanguard of the movement, the method to test the waters.
  9. Visit  Vascular Access RN profile page
    0
    Thank you, Woosha RN, for being brave enough to speak out.
  10. Visit  Vascular Access RN profile page
    0
    "Considering that RTs are paid less AND can bill for their services we will see them expand their roles into other areas of nursing. Vascular access is simply the vanguard of the movement, the method to test the waters."

    Asystole RN: This is not correct regarding Venous Access Device insertion. Some were billing for this, but had to stop.
    Last edit by Vascular Access RN on Oct 28, '13 : Reason: forgot quote marks
  11. Visit  Asystole RN profile page
    0
    Quote from Vascular Access RN
    "Considering that RTs are paid less AND can bill for their services we will see them expand their roles into other areas of nursing. Vascular access is simply the vanguard of the movement, the method to test the waters."

    Asystole RN: This is not correct regarding Venous Access Device insertion. Some were billing for this, but had to stop.
    Banner Health is a big advocate for vascular access RTs, do you know if they as a system have stopped billing? What about productivity?

    I may be wrong but there are now multiple hospital systems utilizing RTs and had this conversation just last week with the rep.
  12. Visit  PMFB-RN profile page
    0
    Quote from chare
    Why wouldn't an RRT run a code?

    What unique skill sets does nursing possess that, in the absence of a physician, only they are qualified to run a code?

    Did you read any of the declaratory statements at the link I provided in an earlier post?
    *** All our RRTs are ACLS too, and valuable members of the code team. But run a code? I can't imagine it. There is no reason why they couldn't but it seems outside their comfort zone, at least for the one's I have worked with.
    In my hospital a variety of people run codes, usually residents, less often a PA or APN, occasionally the RRT RN. I just can't imagine our RTs stepping up to run the code.
  13. Visit  Vascular Access RN profile page
    0
    Can not say more at this time, Asystole RN...I can not identify with any institution or corporation, as doing so may have an ultimate negative affect on patients.
  14. Visit  Esme12 profile page
    1
    Quote from Asystole RN
    Banner Health is a big advocate for vascular access RTs, do you know if they as a system have stopped billing? What about productivity?

    I may be wrong but there are now multiple hospital systems utilizing RTs and had this conversation just last week with the rep.
    I feel it has more to do with removing nurses from the bedside and utilizing alternate personnel, that get paid less, to "do the same job"....thereby increasing profit margin.

    The rep.....is just there to sell their product and some will say ANYTHING to increase the sell. I know someone who sell these and while they are good at their job and know the product they know nothing about nursing, nursing education, or why on qualification is more appropriate than the next. They parrot a scripted sales pitch..they are not even a nurse.
    Vascular Access RN likes this.


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