Can PICC line be delegated? What's the rationale behind it?

[DaisyChains]

So, I know of a patient who was transferred to our facility from another.

The debate concerned a PICC line and that only an RN can give the first dose of Vancomycin.

The Vanc was started in the first facility. But should the initial dose at the new facility be given by an RN too?

and what is the rationale for that anyway?

I had no idea that LPN's could work with PICC lines in the first place.

[AuntieRN]

I didnt think LPNs could do IV meds at all. Will someone please enlighten my on this situation. We dont have LPNs where I work. Thank you.

[txspadequeenRN, BSN, RN]

ive initial dosed vanc among other abt's via picc been doing it for years...

[Preemienurse23]

I know in Texas LVNs can give certain IV meds, (No Cardiac pushes, I don't think they can give blood, at my hosptial, they can't change our TPN,) But they have to take and pass an IV competency test.

[txspadequeenRN, BSN, RN]

texas lvn's cannot do the initial spike for blood. however, the can verify it before it is given and monitor after wards. some places require you to be iv certified some places dont. i have to be in the hospitals and when i do agency...ltc/snf are a different story .

i know in texas lvns can give certain iv meds, (no cardiac pushes, i don't think they can give blood, at my hosptial, they can't change our tpn,) but they have to take and pass an iv competency test.

[Murse901, MSN, RN]

Tennessee LPN's can't even think about touching a central line, but can do almost all IV meds by peripheral access if certified by their facility to do so. No oncologics, no initial hanging of blood, and a few other rules, but the greater majority of stuff is fair game.

It varies from state to state.

[DaisyChains]

So am I right in that the initial dose by an RN is because of peak and trough?

I know that LPN's can get cert. for IV, and this facility does that. And for the person in Texas (I hope I got your state right :) here in Skilled Nursing Facilities, LPN's do "almost" everything that RN's do, with the exception of what has been mentioned already.

Even I'm not clear on what RN's and LPN's job descriptions are. I'm totally confused, but I do know how to asses you, how your major body systems work and I can phone in prescriptions. :) I'm a new nurse, of course I'm confused!

[MoopleRN]

What does a peak or trough have to do with the initial dose?

Where I am, LPNs don't even flush IIVDs (without proper IV certification) let alone mess with PICCs so I can't imagine why only RNs can do initial doses. RNs here do ALL doses.

[highlandlass1592, BSN, RN]

So am I right in that the initial dose by an RN is because of peak and trough?

I know that LPN's can get cert. for IV, and this facility does that. And for the person in Texas (I hope I got your state right :) here in Skilled Nursing Facilities, LPN's do "almost" everything that RN's do, with the exception of what has been mentioned already.

Even I'm not clear on what RN's and LPN's job descriptions are. I'm totally confused, but I do know how to asses you, how your major body systems work and I can phone in prescriptions. :) I'm a new nurse, of course I'm confused!

You should check your policy and procedure manual if you haven't already done so. And you need to check the nurse practice act for your state. By state boards, LPN's may be restricted to using PICC lines as they are usually considered central access. Hanging a dose of Vanc by an RN really wouldn't have anything to do with peaks and troughs, more likely a restriction regarding LPN's initiating IV therapy. That would be my guess. Hope this helps.

[UnderpaidNurse]

In NC, we LPN's were able to push everything except cardiac drugs, and we are not allowed to initiate IV Chemotherapy. I was able to play with all CAVD's. We accessed port a caths as well. We even were able to pull PICC lines. I've moved to California where the mere mention of IV pushes sends people into a tizzy. The only thing LVN/LPN's can do is hang fluids and help to spike blood. It all depends on your states Scope.

[Lucid Vital Nurse, BSN, RN]

I'm an LVN (Licensed Vocational Nurse) in DOU at a hospital in Los Angeles County; and LVN's are not allowed to touch central lines or give anything through them. All we can do is change the central line dressings. In addition, only RN's with special certification can mess with central lines at our hospital; (every other hospital I've worked at, the RN's don't need special certification, so I don't understand that.) We are not allowed to give any meds IVP, NO: piggybacks/drips(K+/CaCl-,Mg++, ABX, Insulin, Levophed, etc), no PCA's; no titration or messing with IV pumps that those meds are running through, etc.

LVN's can choose to become IV and Blood Withdrawal Certified...so we can start peripheral IV's, give IVF's with ca++, Mg++, K+ (diluted in a liter of IVF's), Lipids, SPN/PPN (Sub-Total Parenteral Nutrition [Peripheral TPN]), Blood and Blood Products, Factors....and that's all she wrote. LVN's are very limited with IV practice here in California.

[EJSRN, BSN, RN]

In my facility in NY LPN's cannot touch PICC's or CVP's. They can't hang K, Mg, Blood or any blood products. They can hang any peripheral iv antibiotic. NO pushes. I didn't even know LPN's could do pushes anywhere! They cannot do assessments or even take an order from a doctor verbally or via the telephone. Their job is VERY limited on our med/surg floor.