Critical care procedures

[mercRN]

How many of you in your ED's do central lines, art lines, swans, etc that are Critical care procedures in your ED. We don't do many at all but have to do competencies on them every year. Most of the staff at my hospital have never done them except in competencies. Most of the attending docs that do are supportive if we have never done them and will tell us what they are wanting if we just assist them. Yesterday morning before we left work our clinical coordinator took us into our trauma/code room to work with us on the rapid infuser. It doesn't seem as hard as what I first thought it would be.

[RNin92]

We do ART lines rarely...but they seem to come in bunches!

No SWANs downstairs. We have done central lines fairly often...although I gett he feeling that a lot of our docs are hesitant.

And by the way...why do they always want to put a central line in femorally? Subclavian is soooo much cleaner. They are wimpy!

We have a lot of nurses in teh same boat...only doing things in a competency. A lot of new grads are in our ER. Sometimes it is pretty scary.

[veetach]

we do central lines but not art lines or swans. those are done in our ICU/CCU.

we dont even have to do the competencies.

[traumaRUs, MSN, APRN]

We do central lines, art lines, use the rapid infuser, but not too often, maybe once a month!

[RNin92]

Originally posted by veetach

we do central lines but not art lines or swans. those are done in our ICU/CCU.

we dont even have to do the competencies.

Man...I work in the wrong darn community hospital!!

NO competencies...

Shoot me now.

:o :o :o

[neneRN, BSN, RN]

We do central lines once in a while, maybe weekly or every few weeks. (and they're almost exclusively femoral- I don't think I've ever seen an ER doc do a subclavian) If nurses really can't gain access, our docs will generally try an EJ before attempting a central. Do any of your ERs allow RNs to start EJs?

Art lines maybe every few months.

Never seen a swan in the ER.

Love the rapid infuser, but other than trauma alerts, nobody seems to remember that its there.

[mercRN]

I know our hospital is not supposed to do EJ's but I think there are a few who have and will do them if need be. We are getting ready to do all of our competencies in March. We have JHACO coming in August so we need to do all of ours early. I am hoping to have a night where I can get the art line kit out and not open anything but get out what we would need and set it up so I at least look like I know what I am doing.:)

[RNin92]

Originally posted by neneRN

We do central lines once in a while, maybe weekly or every few weeks. (and they're almost exclusively femoral- I don't think I've ever seen an ER doc do a subclavian) If nurses really can't gain access, our docs will generally try an EJ before attempting a central. Do any of your ERs allow RNs to start EJs?

Art lines maybe every few months.

Never seen a swan in the ER.

Love the rapid infuser, but other than trauma alerts, nobody seems to remember that its there.

RNs are not supposed to start EJs but our FLight Nurses have in a pinch. We have a new NP at our ER and she said her previous ER they could start EJs...but our hospital is WAY behind the times...she is working as a staff nurse NOT an NP...

Do any of your ERs use NPs? We use PAs...but they still have to have EVERY pt. checked bythe docs!??! I fail to see the point!

[mercRN]

Originally posted by RNin92

RNs are not supposed to start EJs but our FLight Nurses have in a pinch. We have a new NP at our ER and she said her previous ER they could start EJs...but our hospital is WAY behind the times...she is working as a staff nurse NOT an NP...

Do any of your ERs use NPs? We use PAs...but they still have to have EVERY pt. checked bythe docs!??! I fail to see the point!

We use NP in our fast track area. We don't use them in the main ED but they do staff fast track. There are times when I think some of them know more than the ED docs do.

[RNin92]

Our PAs are in the fast track side, too. When things are slow they come to the main ED to help. And I know they are all pretty good but they don't function independently. The work under the docs license.

NPs can function under their own. At least they wouldn't have to have the docs clear every pt they see.

But, Illinos being the "land of AMA"...never happen. Man, our NPs only got presecription rights a couple of years ago!!

[Calfax]

It's within our nursing scope of practice in at least 2 states to put in EJ's (AL and NC respectively). I had a disagreement with a physician about it one night and looked it up.

An EJ is a great line, especially if you ain't got no peripheral veins left.....but policies differ as to whether it's a central line or a peripheral line. I know flight nurses seem to consider it a peripheral line while most hospitals consider it a central line.

I put bilateral EJ's in an MI patient a couple of weeks ago....only access until the physician dropped a subclavian. Brought the patient to the cath lab, and was scolded by the cath lab nurse, who looked at both the patient's arms and demanded to know why I hadn't obtained IV access before sending the patient up. Of course the dopamine bag might have been a clue....but I calmly pointed out the access sites and she shut up. In your face, babe!

[athomas91]

And by the way...why do they always want to put a central line in femorally? Subclavian is soooo much cleaner. They are wimpy!

they put them in femorally for 2 reasons....one they are out of the way of all the other "stuff" and two the chances of dropping a lung on insertion is greatly decreased...the fem is the primary site for ED doc's whereas Intensivists will usually used the Subclavian.