CT tech accessing ports

[NRS86]

So does anyone know of or heard of ct,mri, or nm techs accessing ports?? I've never seen this in my experience but at an imaging center I work at they are discussing training a few of their techs to access ports. I know they can use them once accessed but I don't feel comfortable having them actually accessing it. I feel like they are working out of their scope doing this. But maybe I'm wrong and this is a new thing I have not seen yet.. hopefully not though...

[heinz57]

I fully think they are competent, my point was that in my experience I have NEVER seen or heard of them accessing ports. Its the legal aspect of it that I am worried about, especially when they want me to write up the policy and procedure for their company, I do not want my name all over something that implies they can access ports if in fact they cannot. I've been searching all online and have only found they can insert peripheral IVs. The other day I had another CT tech ask me to flush a pt's picc since she cannot do that, so why in the heck would they be able to access a port if they cannot even flush a picc?! Also, the NM tech asked me "so which way is the line facing" and she was pointing the catheter all sorts of different directions. So after that I feel validated that I should question their legal ability to access them.

I didn't mean to come off egotistical, I truly was curious if other nurses on here have come across this in their experience and if anyone could point me in the right direction, thank you to those who provided links! I know it varies state to state too, I just wanted a general idea of whats out there.

Who are "they"? You should not be taking opinions on the anonymous forums or FB to find the answers to their scope of practice. Ask "them" to pull up their scope of practice and the authorization from their Medical Director. If it is in their scope of practice and their Medical Director authorizes it, there should not be a problem.

YOU are also NOT the one whose name will be on the policy. Anything you write while employed by the hospital belongs to the hospital. The staff committee, their manager and their Medical Director will be making whatever changes to what you have written and they will be the ones putting their name to it. You have no authority to determine the scope of practice for other professionals.

Believe it or not but other professionals from other professions help to write protocols for nurses all the time. Oxygen, ventilators, lab equipment (POC, glucometers), VAP, transport, patient assist devices etc all has input from others or even the whole policy written by others. A lot of times a policy or procedure for nurses is just copy and paste with the nurse manager and unit physician signing it.

As far as someone asking about a line, that is only the safe thing to do. Sometimes lines look like spaghetti and only the one who tangled it may know where it goes. I bet (or would hope) you have asked others about their equipment, dressings or procedure and made sure you were doing something right before you messed with it.

I like the ABG example posted earlier. Would you just start sticking an artery because you could or would you learn from those who already knew the procedure well first even if it meant nursing asking the RT or Lab department?

You should feel flattered that they asked you as they may see you as some sort of expert and may respect you. But, I bet if they read your posts here, they might feel differently.

[jadelpn, LPN, EMT-B]

Accessing ports (and as an LPN I have done this zero times) is by observation a sterile technique and multi-steps.

I just don't see the feasibility in being able to do that logistically on a CT table with every step that needs to happen. You just don't stick a needle in and go.

Radiology technicians of every kind go through the most schooling/licensing exams etc. that I have seen in all my years. A course of study that is a "be an u/s tech" stuff is wicked groovy, but doesn't allow one to be registered/licensed most of the time in most states. It takes incredible schooling.

With that being said it is not as if they should not be doing it, or could not do it--it is the feasibility of the same. If a nurse knows that they are going for a scan, then why wouldn't they access the port ahead of time?

What I could see is a radiology tech USING a port--but accessing is a more than inserting an IV which mostly is done outpatient....

Good question, but OP I am not sure of any radiology person who has the time to get into that mess--

[BittyBabyGrower, MSN, RN]

My hubby works in radiology and the radiology nurse accesses the port if it isn't already accessed. Then they can use it as needed for contrast etc. They do start IVs and give contrast and use PICCs.

[applesxoranges, BSN, RN]

In my area, paramedics can access ports in an emergency. I have seen implanted ports accessed. I did think that most radiology departments had an RN on during the day. The other day there was some question regarding the PICC line. I pointed out that it was already "accessed" as she was getting fluids through it but I played along.

[CTtoRN, ADN, BSN, RN]

I am a CT tech and I accessed port-a-caths for 8 years without incidence. The need arose because we have many patients who needed them accessed for outpatient exams and who were not seen by our outpatient cancer care dept (who accessed those patients' ports) This was the Radiology dept and my facility's decision. We were trained by infusion nurses in cancer care, completed a competency with a rep. watched a video, and taught assessment skills/what to look for complications checked for patency, blood return, de-accessed with heparin etc...and did yearly competencies. We have written policies for this.

Mostly, I spent my time worrying about if the ports were PowerPorts or regular ol' ports. We can machine inject both however, with regular ports, we had to lower our PSI down to 50 or 75psi (it really depended on the individual port) and reduced the flow rate down to 1mL-1.5mL/sec in which case you could NOT perform any type of vascular CTA exam (Chest for PE, runoff, etc.). You can really damage a port by injecting at a psi level that isn't rated by the device. Those exams require higher mL/sec rates like, 3.5-4.5mL/sec. Powerports could be injected up to 5mL/sec at 325psi safely. The problem was, pts never knew if they had a powerport or not. You could tell by hand flushing as fast and hard as you could. If there was resistance, we erred on the side of caution and treated it as non-power injectable.

Scope of practice for Radiology Technologists depends on a few different governing bodies. In some states, Radiology Technologists are licensed or registered, and use the designation RT®(CT)or(MR). They will have a scope of practice similar to nursing, and usually as vague. Generally, unless it says "do not" or "can not" they can, according to the state.

If the state has no scope for RRTs, and some do not, their scope is then determined by the ASRT, our professional organization.

Regarding this practice, ASRT states: Vascular Access

"Accessing existing peripheral or central vascular implanted devices or external access lines to administer contrast media, radiopharmaceuticals and medications or maintaining line patency is within the practice standards for radiologic technologists with appropriate clinical and didactic education where state statutes and/or institutional policy permit".

Adopted by the House of Delegates, Resolution 99-3.03, 1999