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.

[EJSRN, BSN, RN]

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.

CAVD?

[Lucid Vital Nurse, 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.

We can't drawl blood from central lines or flush them either. We can only drawl blood peipherally. We can do basic assessments but we have to report abnormalities to an RN and/or MD. We can also take verbal and phone orders.

[UnderpaidNurse]

CAVD?

Central Access Venus Devices...

[chevyv, BSN, RN]

When in doubt, look up the Nurse Practice Act in your state (if your facility doesn't offer guidelines). Here in WI, rn's can delegate this, but not hemodialysis. As far as the first dose, I guess I would go on the when in doubt, its your license, so do it thought.

[suzanne4, RN]

Most definitely check the Policy and Procedure book for your facility as a start and then your BON for their specifics on this.

Each state can set their own requirements and they can differ greatly and it is each nurse's responsibility to know and understand what they can and cannot do.

Never rely on what on what was in doing in one state or a specific type of facility, but check yourself as you are the one holding the license for your state.

A PICC line is a central line and not all states permit an LPN/LVN to have anything to do with them. It also has nothing to do with a peak and trough of any antibiotic.

[mscsrjhm]

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.

There has also been alot of misinformation re LPNs scope of practice. Working the hospital, I had to pull up internet LPN scope of practice for a new LPN instructor--- after showing my assigned students how to flush a PICC, the instructor said "that was very nice, but LPNs cannot touch PICCs or any central line". (In this state they can, and do)

As a new LPN instructor, she was shocked, and had gotten her misinformation from the more experienced LPN instructors.

The transfer may have occurred because of a misunderstanding regarding initiating Vanc, could have been policy, or may have been at the request of the Physician.

[NotFlo]

Until I started reading here I had no idea there were so many places where LPNs can't even so much as flush as PICC.

In my state and in all the facilities I've worked at in this state (LTC and rehab, I've never worked in a hospital) LPNs can do everything with IVs and PICCs that the RNs do. We flush them, hang antibiotics, etc.

Now, in my state these types of facilities cannot do any type of IV push medication at all, so the IV push thing isn't an issue because neither the RNs or LPNs can do IV push so it's a moot point. Any patient requiring an IV push med would have to be sent out. The only exception is a morphine pump on a CMO patient.

In my current facility, none of the RNs start IVs, we automatically call the pharmacy's IV team and they do it. I think it's better that way, because at my old job the RNs would try to do it on these dehydrated elderly people and we would end up with someone with five bandaids up and down both arms and having to call the pharmacy to send an IV nurse anyway. The RNs just didn't perform this skill often enough in this setting to be truly proficient at it but a few fancied themselves IV experts and kept trying and trying but it was always the patient that suffered.

[graceofone]

Just because the scope of practice says an LPN can do it doesn't mean hospital policy says so. For example, in FL LPNs can not spike blood but they can monitor a pt while recieving a transfusion but our hospital policy states an RN must monitor the pt for the 1st 15 minutes after spiking a blood product.

[meandragonbrett]

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

Peak and trough is typically done with the 3rd dose of Vanc.