D/C central lines in SNFs?

Nurses General Nursing

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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...

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.

I've been an RN for thirty years too, and I did say that the CXR requirement is my experience. CXR after removal was routine, as was preserving the cath tip and sending it to the lab for culturing... yes, in every case. I guess the area I worked in had experienced enough pneumothorax following cath removal as well as central line sepsis that they just adopted the two procedures as routine.

Specializes in Vascular Access.

Wow,

Culturing the catheter tip s/p removal on ALL IV's which were centrally placed sound like a huge waste of money and time to me.

PICC's are central catheters, so do they do CXR s/p on their removal as well?

The only time that I would recommend a CXR s/p removal, is when I am discontinuing a central catheter after placing one... i.e. A CXR was done because I removed a percutaneously placed, non-tunnelled triple lumen after a PICC was placed for long term use. I would do the CXR not only to confirm PICC placement, but to verify that when I removed the TLC, I didn't dislodge the PICC from the SVC.

If a RN has knowledge/education on removal of central line catheters, he or she is usually able to perform this task as long as P&P don't prohibit it... And, Yes facilities can be more strict than state regulations. I currently do not know of any states which prohibit RN's from this task, but maybe there are one or two out there.

Specializes in ER, ICU, Education.

Yes RNs can DC central lines - those who have been trained. No they won't code after it is removed as one poster wrote or if they do something else is going on. Getting a CXR afterwards is not the standard of practice. What would be the reason? Think about it. The tip of the line is not in the lungs, it's in the subclavian. What would a CXR show? I think the poster who wrote that is mixed up - you DO get a CXR after one has just been inserted because that's when the doc might have nicked the lung.

Removing one is not much different then removing a PICC line, which is much longer of a catheter but essentially ends up in the same place. The big thing is making sure you get all the sutures out, inform the patient and have them hold their breath during the removal, pull it out smoothly, make sure the tip is intact, if the site looks infected then send the tip of the catheter off to the lab for culture, and make sure you hold pressure at the insertion site afterwards - at least 5 minutes, or longer if they are on a blood thinner. Your facility is the one who dictates who can do this sort of thing. So if you don't have a policy then you need to mention it to your supervisor so they can write one.

Specializes in Med-Surg Nursing.

I know in my area of the country, SNF's don't take patients with central lines. As an RN, I am allowed to remove them. Where I currently work only a DOCTOR can remove central lines and art lines. Which is funny because I usually have to walk them through the procedure and basically DO IT up until the time to remove the catheter.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I know in my area of the country, SNF's don't take patients with central lines. As an RN, I am allowed to remove them. Where I currently work only a DOCTOR can remove central lines and art lines. Which is funny because I usually have to walk them through the procedure and basically DO IT up until the time to remove the catheter.

*** I am not the least suprised that you have to walk a doctor through what is a nursing task. My doctors would think it very strange if we asked them to do basic nursing tasks.

Specializes in Med-Surg Nursing.
*** I am not the least suprised that you have to walk a doctor through what is a nursing task. My doctors would think it very strange if we asked them to do basic nursing tasks.

It is actually part of policy that RN"s aren't allowed to remove central lines or art lines. It's a teaching hospital for doctors and they want the doctors to do it. Go figure.

Specializes in MICU/SICU/CVICU.

I D/C central lines and Swans in the ICU/CVICU, but RN's on the floor usually don't. We also don't do a CXR following. I'm not sure I understand what the necessity for that would be, unless there was a question of complete removal.

Getting a CXR afterwards is not the standard of practice. What would be the reason? Think about it. The tip of the line is not in the lungs, it's in the subclavian. What would a CXR show? I think the poster who wrote that is mixed up - you DO get a CXR after one has just been inserted because that's when the doc might have nicked the lung.

Yeah. I must be "mixed up." The hospitals must not have been reacting to increased incidence of complications with central lines and central line removals, and didn't require CXR and cath tip cultures post removal after all. You're right. I must have a hole in my head. Yeah, that's it. My mistake.

I have DC'd mid lines and PICCs in the patient's home, for example after a six week course of vanc at home. Lots of times. No problem. I was PICC certified at one time, but that had no bearing on my ability to remove a PICC, only to insert one.

Just a little clarification to a previous post - CXR after placement is not only done to check the lungs, but to establish that the tip of the catheter is in the right place. PICCs, for example, can be introduced too far and end up in the atrium - not a good thing. I have never heard of a CXR post-removal.

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.

It doesnt make any sense to get a CXR after central line removal. Whats the purpose of that? I think its a task that can be 100% handled by RNs, provided they get a little of extra training. Its really not a very difficult thing to pull a PICC or CVC.

It is actually part of policy that RN"s aren't allowed to remove central lines or art lines. It's a teaching hospital for doctors and they want the doctors to do it. Go figure.

Its a stupid policy and I sincerely doubt that they are doing it so the "residents can learn it." All the residents I know hate being paged for central line removals, its not some big complicated procedure and its ridiculous that only an MD would be allowed to do it. Its clearly within the scope of ability for a regular floor RN to do.

Central line removals are not like intubations where you need a lot of practice to get it right. I can do a 5 minute demo on it to anybody willing to learn, and unless they are an absolute fool, they will have no problems mastering it without being supervised again.

P.S. Inserting a foley cath is a much more dangerous/complicated process than removing a central line, yet putting in a foley is not something that MDs are required to do. So I dont believe the rationale behind it is because its a "complicated" task.

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