Critical Care Procedures

Advanced Practice Columnist / Guide · Oct 23, 2020

I feel like there is more nuance to this.

Perc trach's are never typically a one-provider operation as you know. It is not uncommon for the perc trach procedure to be done by the trained physician while an NP or PA (or another physician) will drive the bronchoscope and an RT assists with the removal of the endotracheal tube on order by the proceduralist physician. Are you asking whether 2 NP's can independently do the procedure? Or have a physician drive the scope while the NP does the perc trach itself?

Perc trach's fall under the purview of a trained surgeon (Thoracic, ENT) or an intensivist with background in surgery (such as Trauma Surgeons). The procedure is not typically in the armamenatrium among medical intensivists (Pulm, Anesthesia) but their medical license does not prevent them from performing it as long as they are credentialed by the institution so there has been literature out there describing how medical intensivists have been trained and are doing them in some places.

For NP's, your state scope of practice would be your go to. Most BON's aren't going to be clear with the rules, this being a "surgical procedure". Without a clear law saying you can't, a lot of what actually happens in similar cases is establishing precedence (such as NP's doing EVD's). The other question is how the NP can prove that there was formalized training and competence was established and more importantly for NP's, that there is a physician who is available should things go wrong. Institutional politics would be another hurdle.

I personally think that if we get to a point as NP's that we are doing everything that our physician counterparts do, then our pay should be equal because your liability risks are at the same level. Having said that, it should be brought up with your liability provider.

missbutton · Oct 24, 2020

There is a service at Vanderbilt run NPs that only does percutaneous trachs and follows those patients.