CVC placement by Vascular Access Nurses

ED Nurse, RN · Jan 3, 2016

I didn't know centrally placed lines were within our licensing scope of practice? I'm from PA. I mean I've placed pic lines, used us guidance so a central wouldn't be a far stretch to do.

sailornurse · Jan 3, 2016

I know Acute Care NP's that are trained to place but did not think RNs could do this.

VascularNurse1006 · Jan 3, 2016

Hi EDnurse and sailornurse, yes in almost all states (with the exception of about 10) it is within our scope of practice! Definitely working at the top of our license, but within our scope.

I bascially have have the same attitude as you EDnurse, we access veins under ultrasound daily in the upper arm, what is 20cm closer to the body? Haha- if you've poked one you can poke Em' all!!

I learned at the vascular access conference that many nurses are doing cvc insertions and some respiratory therapists are too. Mostly out west (Arizona, I believe).

offlabel · Jan 4, 2016

Hi EDnurse and sailornurse, yes in almost all states (with the exception of about 10) it is within our scope of practice! Definitely working at the top of our license, but within our scope.
I bascially have have the same attitude as you EDnurse, we access veins under ultrasound daily in the upper arm, what is 20cm closer to the body? Haha- if you've poked one you can poke Em' all!!
I learned at the vascular access conference that many nurses are doing cvc insertions and some respiratory therapists are too. Mostly out west (Arizona, I believe).

A couple of questions.... who trains you? How many supervised before independent? How will the lines be used? Which vessels are you allowed to cannulate? Who decides? Are you authorized to move to another vessel if you fail at another site? How many attempts are you allowed before calling for help? Who is your help? Is this in an ICU, floor, clinic, monitored bed? What, if any, monitors do you place? Is there ever sedation involved? How many do you do in a month? Who do you report to with actual or suspected complications? Finally, what size catheters are you placing?

Thanks

VascularNurse1006 · Jan 4, 2016

Wow offlabel- great questions. I'll try to answer them all as you asked them.

The hospital allows us to place them under a physician mentor. The physician mentor supervises 10 insertions and then you are able to place them independently. My partner if inserting alone will have a nurse at the bedside. If I am there, I am with her at the bedside. Same way as if a physician was placing them.

We are trained by a CVC insertion course which is a combination of didactic and hands on training. Like i mentioned above, 10 lines must be placed with supervision. We can use the IJ, axillary or femoral sites. The catheter we place is power injectable (physicians is not), is a 6f triple lumen (physician is a 7f), and is an extended dwell which can stay in for up to 30 days (physician catheter is not). There is no set limit on attempts, i believe it is clinical judgement. There has only been one case that my partner was unsuccessful and that was a guidewire advancement issue. I stated this above, physician tried at a different site and was unsuccessful as well. Ended up placing a femoral CVC. anyway, the ICU physician mentor is our backup. If anything were to go wrong, he would be who we call. this program was initially started to service our Renal patients who were not PICC candidates. For example, if a doc orders a PICC on a renal patient who cannot have a PICC, we place a cvc. Currently, we only insert CVC in ICU. the second phase of the program is to place more emergent lines. There are often times we place CVC on patients who need pressors, more invasive monitoring, etc. Since we are inserting the CVC's in ICU, they are being monitored. Sometimes they are sedated, sometimes they are not. They do not need to be sedated for VAT insertion.

We do track all of our lines. We use the National PICC registry, a very wonderful data collection system!

Thanks for all the questions and sorry for the long winded response but I think i answered them all!

offlabel · Jan 4, 2016

Thanks!

RUmedic · Jan 4, 2016

I believe you need to have CRNI cert and be an NP at the bare minimum in order to place central cath in my state - FL.

From my understanding, in Florida anything like non-tunneled (subclavian, etc.) and tunneled catheters is placed by MD's only.

I am curious to know which states allow/disallow nurses from doing that. I know SC is one that allows RN's to place CC's but to what extent and limitations?

Do you have any links that would shed light on this? Thanks!

offlabel · Jan 4, 2016

Many flight service nurses are trained and authorized to place central lines.

Asystole RN · Jan 13, 2016

I know of registered nurses placing advanced devices like ports.

The vascular access teams placing CVCs tend to actually place more CVCs than PICCs, especially IJs.

Unfortunately, respiratory therapists really seem to be paving the way in CVC insertions with RN based teams catching up.

It is about 1000x easier to place an IJ than it is to place a PICC oddly enough and far safer IMO as long as certain precautions are taken such as using ultrasound.

VascularNurse1006 · Jan 13, 2016

Medic- click this link, it will allow you to check the scope of practice in your state. Let me know if there are any problems! :)

VAS Team - Expand Your Practice

iluvivt, BSN, RN · Jan 24, 2016

We are working on this now and want to expand the Vascular Access Nurse practice to include Insertion of IJ CVADS. Once you have inserted hundred and hundreds of PICCs it will be easy to learn. In fact, I think it will be easier because that internal jugular vein is so huge in comparison to what I have to access