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Discussion

Central line protocols

Ok, so I ran across something new tonight in a post-code pt I was trying to get to CCU, thought I'd get input from other facilities. Long story short: older male, cardiopulmonary arrest, CPR in progress upon arrival, arrives with 18 g in LAC. In the whole crazy mess that is a code, I put an 18g in his foot and an 18g in his EJ. Got a pulse back, stabilized him, put him on Dopamine. Our CCU is notorious (well let's face it.. any CCU) for being hard to deal with and they enjoy finding any reason to not take a patient. So my CCU patients are always stylin' and profilin' (WOO! /Ric Flair). This guy has 18g IV site x 3, criticore foley, 18 fr OG, all clothing removed, all IV tubing orderly, pressures charted q 5 min, yada yada yada.

So I call report and I get about 5 sentences in to report when I get, in a very angry tone: "That patient can't come up here, he's on pressors and he doesn't have a central line. It's hospital protocol."

Alright, I work 6 days a week and take care of CCU patients on a regular basis. I've never heard of this "protocol" and have never had this issue with a patient on pressors before. Any time I have a pt on pressors, they always have 3 IV sites, code or not. So my question for the great minds of AN.com is this: do any of your facilities have this protocol? Granted, in a perfect world, a patient on pressors will have a central line. We don't always operate in that perfect world though. I assumed 18g x 3 is a very reasonable negotiation with that perfect world, but what do I know?

Also, a further question: does anyone in your facility other than the ER docs do central lines? We proposed that the hospitalist, who is an internal medicine doc, put the central line in when he sees the pt in CCU. No dice. "I don't do central lines." Any time someone in the hospital needs a central line, the ER gets called. I guess I halfway want to vent as well, because we get so much flak for "doing nothing." Grrrrrrr.

Anyway, input on this whole central line protocol would be much appreciated. Just curious to see how other facilities operate. Thanks guys and gals.

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    A lot depends on the size and type of hospital. In our case, our group has 5 hospitals in our particular region. While they all do elective surgeries, the central, larger hospital does most of the emergency surgeries, has the cath lab, etc. My particular hospital has an ED with 18 main ED rooms + up to five hallway beds, two 'fast track' rooms with a number of chairs where these pts once examined can sit and wait for diagnostic procedures or discharge. Oh, and the main ED also has five other recliner type situations where pts can be pulled from main ED rooms once initial workup is done if the main ED bed is needed for something else. This is a smaller ED than our central, trauma ED (with cath lab) is.

    Our ICU has, I can't remember for sure, 9 or 10 beds.

    I guess my main point is, small hospital with small staff. There is no 24/7 surgery so no 24/7 anesthesiologist. And, our ED is small enough that approx 1/3 of the day we only have 2 ED docs, and 1/3 we only have 1 ED doc. If that one ED doc is swamped...

    DC :-)

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    Goes case by case, if the patient has pipes we feel comfortable to admit with at least 2 large bore IV's. If they have crap for veins, the ED doc will throw in a CVC before admission. Sometimes we have the time to do everything, sometimes not. But our policy is CVC within 12 hours of pressors.

    I wish we had more PICC nurses...

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    No. We don't have this policy. Frankly, if you have someone refusing report, say " ok, if you refusing report, I will contact bed management. If they believe their story, they will stick with it. Otherwise, I don't do drama.

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