Arterial line insertion by the RN

Specialties MICU

Published

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.

Specializes in SICU/CT-SICU.

We don't insert A-lines, although I wish we did, as sometimes it's painful to watch Interns struggles to get one. RNs and RTs can draw AGBs.

We dc Swans, but do not advance them. We maintain CVVH, but do start it. We do not place central lines, IV nurses places PICCs and the MDs place other CLs.

Some of the nurses I work with pull Medialstinal CTs, but I don't and don't really have an desire since I'm not good at reading CXRs.

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Specializes in ER, ICU, Infusion, peds, informatics.
ours do, and as a nurse, whenever i pull out supplies and scan them in the bcx.... i've billed.

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.

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.

and on an inpatient level, the hospital isn't even able to bill for supplies.

[color=#483d8b]insurance companies pay according to drgs, not what the patient received. connecting the supply with the patient via "charging" systems does three main things:

[color=#483d8b]1. helps to support what the billers code for, drg-wise

[color=#483d8b]2. helps with inventory

[color=#483d8b]3. helps with allocation of the budget throughout the hospital

[color=#483d8b]for outpatients (including the er), it is a little different and those departments can bill for certain supplies, but not all of them.

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We don't insert A-lines, although I wish we did, as sometimes it's painful to watch Interns struggles to get one. RNs and RTs can draw AGBs.

We dc Swans, but do not advance them. We maintain CVVH, but do start it. We do not place central lines, IV nurses places PICCs and the MDs place other CLs.

Some of the nurses I work with pull Medialstinal CTs, but I don't and don't really have an desire since I'm not good at reading CXRs.

Interns/residents insert A-lines. Only RTs/MDs/Midlevels can draw ABGS on our unit (w/out an A-line in place).

We d/c Swans, we don't advance them - although I would say all of us have at one time or another. We start CVVH (pain in the butt!), and maintain it.. PA's place our PICC's, and interns/residents/midlevels place other central lines.

We d/c mediastinal and pleural chest tubes and blakes. Interns/residents/midlevels read the CXRs. Our NP's d/c epicardial pacing wires.

It's interesting to see the differences between all of our units.

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Specializes in SICU/CT-SICU.
Interns/residents insert A-lines. Only RTs/MDs/Midlevels can draw ABGS on our unit (w/out an A-line in place).

We d/c Swans, we don't advance them - although I would say all of us have at one time or another. We start CVVH (pain in the butt!), and maintain it.. PA's place our PICC's, and interns/residents/midlevels place other central lines.

We d/c mediastinal and pleural chest tubes and blakes. Interns/residents/midlevels read the CXRs. Our NP's d/c epicardial pacing wires.

It's interesting to see the differences between all of our units.

Wow, that is a big difference. You guys do a lot, but it seems weird to me that you guys pull pleurals, but they don't let you draw ABGs?

Our NPs or PA pulll epicardial wires as well.

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Specializes in Adult ICU/PICU/NICU.

Only the docs start A-lines here, although I've goofed a few times when going for an IV and ended up started an A-line by accident.

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Specializes in MICU/CICU/Currently CVR.

Working at 4 different hospitals in 4 years has taught me to QUICKLY learn what is it I can or cannot do.

To those of you who start a-lines, do you only do radial?

A dedicated line team is a night nurse's DREAM!!!!:D

I think it's funny what my hospital sets as standard....RN's can twiddle with the vents all day long but we can't do arterial sticks (doesn't always stop us from doing it....you do what you have to do...).

I would :redbeatheLOVE:redbeathe to put in my own a-lines!!!!! I :madface:Hate:madface: begging for lines. (this coming from someone who has( on more than one occasion) titrated levo/neo/dopamine/etc. to a cuff pressure:madface:!!!

KC :specs:

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Specializes in ICU, ER, EP,.
and on an inpatient level, the hospital isn't even able to bill for supplies.

[color=#483d8b]insurance companies pay according to drgs, not what the patient received. connecting the supply with the patient via "charging" systems does three main things:

[color=#483d8b]1. helps to support what the billers code for, drg-wise

[color=#483d8b]2. helps with inventory

[color=#483d8b]3. helps with allocation of the budget throughout the hospital

[color=#483d8b]for outpatients (including the er), it is a little different and those departments can bill for certain supplies, but not all of them.

next admit, ask for an itemized bill. from a personal perspective, some billable supplies were denied as "unnecessary" from my own admit. now, i'm not suggesting that every billable item is covered by insurance... this varies too off topic from the post. how the insurance company reimburses is not the issue... i

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

I also insert Piccs, but Im certified, Im also a Supervisor. No radial is not the only art line my nurses do. Art lines can be a pain to insert, sometimes more difficult then an IV.

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If the nurse can draw an arterial blood gas, then this is not any more painful and not much different in the technique in placing an a-line.

That`s the right answer. What`s a difference between "simple" art-line placement and complicated art blood sampling for ABS? No difference.

From patient point of view, this procedure should be done by licenced expert. Nurse or MD?...Hm...whatever...just to be skilled.

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Specializes in SICU/Trauma.

I never have heard of an RN doing an A-line! I thought it was a MD responsibility only! I have seen some pretty bad outcomes of a-lines that people have messed up because of a hard stick! I don't think I want that responsibility!

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....RN's can twiddle with the vents all day long......

>

Yikes!

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RT's do the a-lines at my facility. We also have CV-techs, who are further trained RT's-they do our PICC lines and set up our PA caths when a pt. returns from OR, they also line out our balloon pumps when a pt. returns from OR. They are an excellent resource when we are busy hanging/titrating gtts and don't have time to mess with time consuming procedures.

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