Is anyone out there placing central lines? My role is a vascular access nurse and currently I place midlines and PICCS as well as ultrasound guided IV. I will soon be trained in central line insertion. I'd like to know if anyone else out there is placing them? What state are you from? How many do you do in a week?
My partner has been placing them since last January. We received a little pushback from the physicians at first but most have been supportive. So far she is successful on one stick attempt, one patient she was unable to thread the wire (doc tried too thinking he could "get it" and had the same problem! Patient ended up with a femoral line) and no complications (pneumo, hematoma, infection). She has a 100% placement in the lower 1/3 of SVC/CAJ using our tip navigation system and then she initially confirms no pneumothorax under ultrasound by verifying sliding lung. We still do a CXR to confirm no pneumo.
If if you're placing central lines, please share your story!
I love this! I often have wondered if I could ever be trained to place central lines. My biggest criteria issue is renal patients. Placing traditional CVCs would resolve this issue.
When you say mentor, who is that? We have Critical Care physicians but we do not have a doctor in the ICU at all times.
I love this! I often have wondered if I could ever be trained to place central lines. My biggest criteria issue is renal patients. Placing traditional CVCs would resolve this issue.
When you say mentor, who is that? We have Critical Care physicians but we do not have a doctor in the ICU at all times.
HMarie, Please remember that since you say that you are placing PICC's, you already ARE placing central catheters! Now, if you want to place Percutaneously Non-Tunneled Central lines, that is a different ballgame.
Hello...I know this is a little older post , but I have ran across some issues I would like to get more information on. I currently live in Kansas but mostly work on the Missouri side. I am currently a vascular access nurse at a children's hospital. Currently we only do Piv/labs, PICC placement, and monitoring of all central lines. We are looking into expanding our skills within our scope of practice. My main question would be where to find information on if we are allowed to place femoral lines as well as IJs and art lines. This questions comes from our IR department wanting us to exchange their tunneled lines. If we were to do this where can I find information on doing this safely. There is argument whether we should do this amongst our team, but in my mind we should be competent and "safe" to do this if we are expanding to placing IJs.
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!
Hello...I know this is a little older post , but I have ran across some issues I would like to get more information on. I currently live in Kansas but mostly work on the Missouri side. I am currently a vascular access nurse at a children's hospital. Currently we only do Piv/labs, PICC placement, and monitoring of all central lines. We are looking into expanding our skills within our scope of practice. My main question would be where to find information on if we are allowed to place femoral lines as well as IJs and art lines. This questions comes from our IR department wanting us to exchange their tunneled lines currently. If we were to do this where can I find information on doing this safely. There is argument whether we should do this amongst our team, but in my mind we should be competent and "safe" to do this if we are expanding to placing IJs. If you are competent in placing CVLs does this include femoral and axilla always? I ask because I know there are many different skill and comfort levels on our team. Thank You!!
Hello...I know this is a little older post , but I have ran across some issues I would like to get more information on. I currently live in Kansas but mostly work on the Missouri side. I am currently a vascular access nurse at a children's hospital. Currently we only do Piv/labs, PICC placement, and monitoring of all central lines. We are looking into expanding our skills within our scope of practice. My main question would be where to find information on if we are allowed to place femoral lines as well as IJs and art lines. This questions comes from our IR department wanting us to exchange their tunneled lines currently. If we were to do this where can I find information on doing this safely. There is argument whether we should do this amongst our team, but in my mind we should be competent and "safe" to do this if we are expanding to placing IJs. If you are competent in placing CVLs does this include femoral and axilla always? I ask because I know there are many different skill and comfort levels on our team. Thank You!!
As someone who has been placing IV catheters of all kinds (Peripheral, Midlines and PICC's) I can say that MO does NOT have that in our practice act yet, that I know of. Looking at the MO NPA-PDF, I don't see any references to a RN placing non-tunneled femoral or jugular/subclavian IV catheters. I'd email the board and have them answer it.
VascularNurse1006
11 Posts
Where are you located?