Arterial line insertion by the RN

[CactusFlower]

Any of you starting your own artlines? At my current facility this is under the realm of respiratory. Have had too many bad experiences for some reason and I want to get my hospital to get the P&P started with an instructional program for the ICU RNs.

[meandragonbrett]

Art line insertion is a procedure that is billable. RN's cannot bill. If RNs were allowed to do art lines, that would take away billable procedures for clinicians. I just don't see it becoming a widespread practice anytime soon.

[cardiacRN2006, ADN, RN]

Can RT's bill?

[meandragonbrett]

Can RT's bill?

To the extent of my understanding (somebody correct me if I'm wrong here), but no the RT's cannot bill either. With RNs and RTs not being able to bill for their services, you would think hospitals would restrict a-line insertion to physicians, APNs, and PA's. Maybe i'm missing something here. Anybody else have an idea?

[cardiacRN2006, ADN, RN]

RTs do Alines in my hospital

[platon20]

Just underscores my belief that RN's should be the ones starting ALL lines in the units,but I know few others share my views on this.

Dont agree. Best case scenario is an IV/line team that does NOTHING all day but float thru the hospital and draw blood, put in IVs and art lines.

An IV team that does nothing but sticks 24/7 is far better than any MD or RN who does an occassional art stick

[platon20]

To the extent of my understanding (somebody correct me if I'm wrong here), but no the RT's cannot bill either. With RNs and RTs not being able to bill for their services, you would think hospitals would restrict a-line insertion to physicians, APNs, and PA's. Maybe i'm missing something here. Anybody else have an idea?

Hospitals dont see the money that doctors can bill for art lines, so from their perspective they dont really care who does it.

Art lines are actually a poorly reimbursed procedure anyways, most docs would rather use their time to do more lucrative procedures. That explains why most are content to let others do it. The only exception is teaching hospitals, in which medical residents need to learn how to do them and thus are more likely to get these sticks.

[blueheaven]

LOL I've accidently stuck arterially when inserting an IV, I always ask the doc if they want it to stay in. Where I work the interns, residents and fellows put in lines.

[PICC ACE]

"An IV team that does nothing but sticks 24/7 is far better than any MD or RN who does an occassional art stick"

This is in fact exactly what I envision. Case in point--one of my patients yesterday needed an art line. Resident,then fellow then anesthesia resident poked and jabbed and made a mess of her wrists. They agreed to let me have a shot and I showed them how I use a Doppler to do it and got right in.

Little by little vascular access has evolved over the years. Nurses took over peripheral IV placement years ago,something once viewed as an MD act. 10 years ago no one would have believed that nurses would be using ultrasound and modified Seldinger techinique for PICC's but today that is the norm. Nurses in other countries have begun to place tunnelled IJ's,Hickmans and HD catheters. I know I am totally biased,as a former IV/PICC nurse now in the ICU,but I am all for RN's expanding their practice and patient outcomes trumping reimibursement and 'tradition'.

[NewTravie]

The two ICU's I have worked in it is the Docs or midlevels that put art lines in. Its something that would be cool to learn but IMHO nurses have enough to do already in the ICU.

[Nacki, MSN, NP]

I've never been anywhere where nurses do them....Although I would like to learn. I wouldn't want to be responsible for putting one in a crashing pt I just admitted among other things I needed to do. I would like to put lines in for pts who aren't mine!

[Zookeeper3]

Can RT's bill?

Ours do, and as a nurse, whenever I pull out supplies and scan them in the BCX.... I've BILLED.

Nurses and RT can insert Alines.. as nurses we reposition swans, yes advancing. It is dependent upon the individual state boards.

As nurses, we do not do any RT treatments because billing is set up through the RT dept and they don't want to give it up... billable hours and billable treatments protect postitions.

Many states vary. To me, the more people able to do clinical proceedures the better. (assuming a good didactic and check off period)

[CraigB-RN, MSN, RN]

Ours do, and as a nurse, whenever I pull out supplies and scan them in the BCX.... I've BILLED.

Nurses and RT can insert Alines.. as nurses we reposition swans, yes advancing. It is dependent upon the individual state boards.

As nurses, we do not do any RT treatments because billing is set up through the RT dept and they don't want to give it up... billable hours and billable treatments protect postitions.

Many states vary. To me, the more people able to do clinical proceedures the better. (assuming a good didactic and check off period)

Actually you haven't billed for the service, you've input the information for the hospital to bill for the equipment. As nurses we're included in the room rate, no matter what we do, one of the reasons we're paid at the pay scale we are.

Personally I"ve got to much to do as it is withouth adding one more thing to the list. As long as the people who can do it are there in a timaly maner. I"d rather have dialysis start the CVVDH, (i'll maintain it) and I"d rather have someone else put in the Aline while I"m getting the levo and neo ready.

Now I'f i'm flying, that's another story. The places I pic patients up don't have access to any advanced hemodynamic monitoring. I put in the A-Lines, so I can monitor during the flight. I used to put in Sub-Clavians but I haven't done that in about 10 years. Haven't realy missed it either. (was able to do that not becasue it was included in scope of practice, but because it wasn't prohibitied, not the safest way to do something)