Femoral Sticks In Scope Of Practice For Rn????????

gypsyatheart · Jun 5, 2004

The question wasnt about abg's. it was about central vessel sticks (ie Fem artery). What do you mean by ambiguous? And the flight-nurse you spoke of is taking huge risks (unless of course he was 'trained' and 'expected' to (i'm betting neither)...and why in the heck would a flight nurse be drawing areterial blood...or any blood for that matter? abg machine or lab machines on board his chopper??

Actually, the OP did mention the ability to do arterial sticks, period, in addition to femoral sticks, etc. She states she is a new nurse, so information is being offerred in this vein.

Also, it is feasible for a flight crew to do their own ABG's. We have the I-Stat machines, small, portable....no reason they can't use 'em.

Dinith88 · Jun 5, 2004

. She states she is a new nurse, so information is being offerred in this vein.
Also, it is feasible for a flight crew to do their own ABG's.

E-vac choppers are ambulances that fly. Ambulance crews/Paramedics dont deal with lab values (including abg's), as their primary function is to get people to hospital..fast.

If a chopper crew is drawing, interpretting(sp?), and treating abg's it's not the norm.

(A few chopper-crews i've dealt with have doc's(residents on rotation?) that fly as part of the team. These crews may do things differently...i dont know. but i'll certainly be asking the next one i see.)

Regardless, if a helicopter crew is drawing abg's, a femoral stick attempt inside a vibrating helicopter would be pretty darn dangerous (stupid?)...and out of the scope of practice for a nurse...even the ones who are lucky enough to fly in helicopters.

and again, the issue isnt so much abg's as it is central vessel sticks....and i'd challenge anyone to show me a policy that states it's acceptable nursing practice.

gwenith, BSN, RN · Jun 5, 2004

Dinith - I have done arterial sticks in the "sticks" i.e. country where we did not have a Doc 24/7. As for the flight nurse - one of the FIRST things we are taught here is to make sure the patient is stable before you get them in the plane. We do nto have the portable lab machines but I can tell you if we did we would be doing lab values before we ever left the hospital we were retrieving the patient from - much much much safer that way.

mitchsmom · Jun 6, 2004

E-vac choppers are ambulances that fly.

(A little OT, sorry)... you don't feel that medevac helos are more advanced than ground ambulances?

Dinith88 · Jun 6, 2004

Dinith - I have done arterial sticks in the "sticks"
THats a pretty funny play on words
Gwenith, have you done femoral artery sticks? I know i'm sounding a little over the top (PITA)....but again, i wasn't debating areterial sticks...only femoral artery sticks...especially in a helicopter. It's unfortunate, but even in the cath-lab (best/controlled conditions) where people (cardiologists) do fem. artery sticks ALL THe TIME, patients develope retroperitoneal bleeds...which can be (usually is ) an emergent situation that can kill someone...especially unstable-type patients who might require helicoper lifts!
And then there's always a chance to puncture/sever the nerve that runs alongside the artery....
anyway, i'll stop beating this dead horse now....
and to Mitchsmom,
, helo-ambulances are surely packed with the latest gadgets offered, but are still just that...flying ambulances.

mattsmom81 · Jun 6, 2004

Hey mattsmom,...
So, why were you needing to stick a femoral artery in a code? And did the patient have a pulse while you were doing it? If the pt was pulsless, it was a BIG error to go digging blind into someone's groin...And if there WERE a pulse, it would seem other access (for abg's??) might have been gotten. The only time i've seen femoral sticks during a code was to obtain abg's on a pt we werent able to obtain from the radial..(and the fem stick was done by a cardiologist....
And any nurse that goes jammin a needle after someone's jugular is just asking to get in trouble. Nurses doing any central sticks (in a code, trauma, or whatever) are WAY out of nursing scope... If you nick a carotid (especially during a code!) you can kiss the patient good bye...and what were the doc's doing while you were sticking femoral arteries and jugular veins?? Were the doc/doc's just standing around while the nurse was poking a central vessel??? And if a nurse is running a code without a doc present, she would be stupid to go sticking central vessels (imo).
I'm willing to bet that you've never been formally 'trained' to do these sticks (femoral artery, jugular vein, etc)...so why would you be asked or expected to in a code (you said you've done it lots of times??)..?
Also, In controlled situations (in the cath-lab, where cardiologists stick femoral arteries all the time) under the best/oportune environment, people get retro-bleeds ALOT...In an uncontrolled situation/code, where a pt's pulse is thready at best, a fem. stick is SO dangerous and can easily cause retro bleeds or cause limb paralysis (a big nerve (sciatic or vagus??) runs just-lateral to femoral arteries and can be 'run-through' very easily)
I dont disagree that after seeing it done a bazillion times, a nurse could probably do these sticks no problem...but still...
I'm not saying i dont beleive you...I'm just a little taken aback that your hospital allows nurses to do this stuff...code or no code.

In a code situation when the one and only doc is trying to intubate nurses sometimes do what we can, based on our individual comfort level and experience. I don't 'dig' for IV access of any kind and I don't need a lecture. Do not assume you know accepted practices in every area, situation and facility for every nurse...there are nurses (like first assistants, trauma nurses, flight nurses) who feel comfortable in certain settings doing more than you or I might do. I don't judge them as its their license not mine.

Our obligation is to know our NPA, and our PP's and to make a sound decision but I am not so naive to assume all nurses would always make identical decisions. Life doesn't work that way and that is why critical thinking is so important in our practice.

We work in different types of facilities, no doubt. A reasonable and prudent nurse in your area and setting might well make a different decision than I.

Trauma Columnist · Jun 6, 2004

In Illinois - we (ER nurses who have been trained) do access EXTERNAL jugular VEINs for IVs if no other peripheral site is available. We also can and do perfrom ABGs on radial and brachial arteries - again if trained and competencies checked.

Dinith88 · Jun 7, 2004

In Illinois - we (ER nurses who have been trained) do access EXTERNAL jugular VEINs
Ok... just a quick question or 2
who trains these nurses? Are these 'trained' nurses insructed on central-line placement or just accessing a jugular with the usual needles??? Is this a formal competency? An informal 'watch and learn'? And would you be willing to name a hospital/hospitals that 'train' nurses to 'go for the jugular' ?.
And i noticed the accentuated 'EXTERNAL' jugular vein...regardless, there're 'external' carotids that run medial to these veins.
And i dont buy the whole 'doc may be busy intubating' thing...a jugular access and intubation can't be done simultaneously (can you imagine that?).
I still say that if central vessels are being poked, it's the doc's that should be doing the poking. And although 99 times out of 100 the jugular stick'll go well, if it doesn't...sheesh.
Now, paramedics in the field may be a different story. No access, no doc's, no other choice...