D/C central lines in SNFs?

[nyteshade, BSN]

Hey everyone,

This is really bugging me...Can RNs D/C central lines in the SNF setting? I know it's within the scope of those that have been trained, and I've researched that not every RN can depending on what setting they work in (but this is in regard to the hospital setting). My facility protocol mentions nothing. Help! This is in Florida by the way...

[TheCommuter, BSN, RN]

It depends on the policies and procedures of the facility in which you are employed, as well as the state BON.

I am in Texas, where RNs always D/C central lines in nursing homes, SNFs, and other LTCFs, as it would not make financial sense to send the patient out to the hospital just to have another RN complete the same task. As long as the RN in the nursing home has undergone training in central line care, then it is permissible to remove it in that same setting.

[pennyaline]

Do you mean LTAC or SNF? SNFs in my area do not take admissions with central lines. The only temporary long-lines we are able to handle are PICCs. But it's my experience that central lines require CXR after insertion and after removal. If that is still the case, best to just send the resident out to have it done.

[leslie :-D]

Do you mean LTAC or SNF? SNFs in my area do not take admissions with central lines. The only temporary long-lines we are able to handle are PICCs. But it's my experience that central lines require CXR after insertion and after removal. If that is still the case, best to just send the resident out to have it done.

i agree w/you...

in that i've never known a ltc facility to be able to pull any lines other than piv's, mid or picc lines.

at least at a hospital, there's plenty of backup if something goes wrong.

and yes, you need xray to confirm total removal.

leslie

[classicdame, MSN, EdD]

I also work in Texas and every hospital I have been in has a policy against it unless the nurse is a CRNA. Too easy to get a code going.

[nyteshade, BSN]

No, Pennyaline...No LTAC, just plain ole SNF. What confuses me is that I've worked in the hospital setting, and couldn't pull a central, so I wonder why it's ok in a SNF? We have IV nurses contracted with the facility, so their is no need to send out either...

[PMFB-RN, RN]

Here in Wisconsin it is standard for nurses to D/C central lines. It is after all a basic nursing task taught in nursing school. Of course your facility should have a policy and procedure in place and you should follow it. On very small hospital I worked at didn't have policies and procedures for lots of things. They simply made a policy that we follow a particular nursing text book as our policy and procedure guide.

[Bella RN, BSN, MSN]

I have never seen a CXR taken after a Central line is removed. Not even when a cordis is removed. I have seen of course after placement a stat cxr. I am in Florida and worked CVICU /CSUand MSICU. hmmm interesting I will look into this.

[scoochy]

CXR after central line d/c'd?? I have been a nurse for 30 years, and it was never routine to obtain a CXR after the central line was removed unless there was a concern re: difficulty with removal.

With regard to the post stating that d/c'ing a central line is a basic nursing task taught in nursing school, I say, wow, I never learned it in nursing school! In the hospitals where I worked, central lines could only be d/c'd by nurses working in critical care settings. IMO, removal of a central line is not a basic nursing task!

I currently work in a LTC facility; PICC lines are only discontinued by the MD or APRN. Every facility is different, and there are state regulations that must be followed to the letter!

[Bella RN, BSN, MSN]

I agree with you Suzie,RN, I have NEVER heard of obtaining a CXR after Central Line removal. I have been an RN for 9yrs. I was puzzled when I read that. I thought it was just me.

[PMFB-RN, RN]

I currently work in a LTC facility; PICC lines are only discontinued by the MD or APRN. Every facility is different, and there are state regulations that must be followed to the letter!

*** Oh I would never trust an MD to remove a central line unless it was anesthesia. Our docs don't have any idea how to do it, or if they do they haven't actually done it since their residency. Your average family practice or IM doc would have no idea at all. I don't know about LTCs but in the hospital where I work it is certainly a nursing task and not just in the SICU where I work but on the regular med-surg floors as well.

[scoochy]

The MDs I work with in the LTC facility DO know how to remove a PICC line. I have observed them doing it...no problems. I am fortunate to work in a LTC where the physicians are dedicated to the care of the elderly, and are not just there for the $$. And to boot, they really do know what they are doing!