Since I am new and have no idea regarding Dialysis, I have many questions.
So here are a few regarding PCT's and me as the soon to be LVN that will be liable. I am very nervous about my license being at stake and I am not sure what is normal and what is not.
In your Facility what do your PCT's do?
Are they accessing everything but Catheters?
Are they drawing up the Heparin, Lidocaine and Saline then labeling it? If so how are we supposed to know that what they drew up is really what they say it is?
The PCT's in ours set up the packs, meening they draw up the Heparin and label it. Then they put it in the packs for the Catheter pt's. so the packs are ready even before they pt. gets there. It makes things flow nicely, yes, but I am just wondering how we are guaranteed that this is what the label actually says it is. They also draw up lidocaine if pt's need it. My concern is, the lidocaine sits next to the Heparin and in the 4 days I worked this week. I found the lidocaine in the Heparin box twice. I also say several predrawn Heparins that weren't the amount the needed to be, say like the pt was supposed to have 8000 Units, the tech would pull back to where they thought 8ML's were and that was it, but when I would look at it, it would actually be under or over by as much as 1ML. So being the nice, sweet person that I am, I wouldn't say anything, but fix what they did wrong.
Since I dont' start theory part of the orientation till next week, but have been drilled to death in school about exact amounts, I am thinking that if the Dr. ordered. 8000 units, shouldn't it be exact rather then almost?
And my other thought is, when it is me that is responsible for the heparin on the catheters, shouldn't something be said about, unless you are giving it, don't draw it up?
Oh, one other thing, Say the RN in Charge does an access, because it is a tricky one, shouldn't that Nurse be responsible for documenting the Bruit and accessment rather then the PCT. I was told yesterday by the PCT, "here, go ahead and check that the Bruit was good, and his resp's were OK." I said, "I didn't feel the Bruit, I watched the Nurses technigue, I didn't touch that pt." She said back to me, "That is OK, we always do this section of the sheets." I gave the pen to her and said, here show me what you mark. And left it at that.
It makes me nervous about these kind of practices, I don't want to step on toes, but feel this is my license I need to protect. Am I being overprotective?
Folks, only a licensed person, RN, LPN,etc can draw up medications, heparin, lidocaine, etc are medications. This seems to be a aspect we as professionals are sleeping on. Remember the person who administered the medication will be the one in court whether you drew it up or not. One of the first things in Nursing School was didn't draw,pour or open the pack then don't administer or sign your name.
I don't understand why this is a question in so many units, I hear this all the time. I think if the higher ups give you a hard time about not following this dangerous practice then ask them for this policy in writing and if they hand it to you then make ten copies, send it to the health department and retire early
Folks, only a licensed person, RN, LPN,etc can draw up medications, heparin, lidocaine, etc are medications. This seems to be a aspect we as professionals are sleeping on. Remember the person who administered the medication will be the one in court whether you drew it up or not. One of the first things in Nursing School was didn't draw,pour or open the pack then don't administer or sign your name.
I don't understand why this is a question in so many units, I hear this all the time. I think if the higher ups give you a hard time about not following this dangerous practice then ask them for this policy in writing and if they hand it to you then make ten copies, send it to the health department and retire early
Must disagree with you here, Mossflower.
Dialysis units are run differently according to state laws. Dialysis techs ARE permitted to draw up and admisister heparin, lidocaine, and administer 02, depending on the state.
Dialysis units are run differently according to state laws. Dialysis techs ARE permitted to draw up and admisister heparin, lidocaine, and administer 02, depending on the state.
Hello
Well I'm from NY and that's not permitted here, although it's done and no one questions why. I can't see any state allowing unlicensed personal to administer medications or even draw them up, who will be held responsible if a mistake is made? How are the persons deemed qualified to administer medications? Is there a certification requirement, training course? I don't think I would be very comfortable with this, do the techs sign their names that the drug was administered? Forgive me but you're blowing my mind. I know when I sign my name RN goes behind it, and I am accountable for what I give, NY laws are pretty tough if you screw up. If the techs give the meds and sign does a nurse co-sign? We must co-sign the flow sheets, pre and post for the UF target, cannulations, etc, but the nurse signs and gives all medications. We also do all the catheters, I know there are some places that allow techs to initiate permacaths but we don't, and don't quote me, but I believe in NY licensed staff for pcs only, although I know of units that do allow some techs to train and complete a certificate course to put on the catheters, not sure how they get around the state but it's done.
Well I'm from NY and that's not permitted here, although it's done and no one questions why. I can't see any state allowing unlicensed personal to administer medications or even draw them up, who will be held responsible if a mistake is made? How are the persons deemed qualified to administer medications? Is there a certification requirement, training course? I don't think I would be very comfortable with this, do the techs sign their names that the drug was administered? Forgive me but you're blowing my mind. I know when I sign my name RN goes behind it, and I am accountable for what I give, NY laws are pretty tough if you screw up. If the techs give the meds and sign does a nurse co-sign? We must co-sign the flow sheets, pre and post for the UF target, cannulations, etc, but the nurse signs and gives all medications. We also do all the catheters, I know there are some places that allow techs to initiate permacaths but we don't, and don't quote me, but I believe in NY licensed staff for pcs only, although I know of units that do allow some techs to train and complete a certificate course to put on the catheters, not sure how they get around the state but it's done.
Yes, as I say, it varies from state to state. Dialysis facilities are regulated differently. I'm not saying it's right or wrong.. just stating it as it IS.
The PCTs undergo a six week training in classroom and then a lengthy orientation to the floor. They do sign for the heparin bolus they give, as well as any heparin used in the pump. We do not use lidocaine, period, so we don't have to deal with that.
The licensed staff cosign the flowsheets, just as you do. We do not cosign the heparin specifically.. just the flowsheet itself for pre and post assessments, etc.
Our techs do access catheters, instill the heparin blocks, and do the dressing changes as well(after six months on the floor). This is all taught during thier initial training.
As of yet, the PCTs are not "certified" per se, but I hear that this will soon be mandatory. There will be a certification course for all dialysis PCTs.
This is an interesting older thread that deserves to be resurrected for the benefit of new dialysis nurses. Many nurses who came from a hospital may not be aware how the role of unlicensed personnel may differ depending on the setting (acute care hospital, freestanding clinic, doctor's office, etc.) and from state to state.
I know I was in for a surprise when I started training in a clinic of a large national for-profit dialysis company back in '99. In the hospitals where I had worked before LPNs weren't even allowed to give IV meds (this has since changed by the state board of nursing); in the dialysis clinics, however, they were. That was not what shocked me, though.
According to my company's P&P, unlicensed patient care techs could "give medications and do assessments according to state laws and regulations". The meds most frequently referred to were, of course, heparin and lidocaine; nowhere did it state, however, that PCTs could actually draw any meds. Only licensed nurses (RNs and LPNs/LVNs) could do so and label them accordingly; thus labeled, other nurses could give these meds (according to P&P; not according to what I had learned in nursing school ).
I had previously worked on two hospital floors where you had to have another nurse double-check your insulin and SQ heparin doses! So imagine my surprise when I read this P&P which was issued by the corporate office in another state. I soon learned that state laws varied widely regarding the roles of PCTs and even LPNs/LVNs.
In Florida, PCTs could only give NS boluses (and sign them off/do the appropriate charting); no heparin, no lidocaine, and certainly no other meds. They also could not do any assessments. Back then, they were not allowed to access CVCs; this has since changed, however (yes, they can put on and take off catheter patients; however, they are not allowed to change the dressings).
What happened in actuality is part of the reason why I cannot return to an outpatient setting. State law is widely ignored by nurses only concerned with speed (get them on/off in record time). I have seen RNs let PCTs draw up and give heparin (various strengths: we had 1:1000 as well as 1:5000 and 1:10,000 for the CVC ports); do assessments, or simply not assess the patients at all; let the PCT change the dressings/or not change them at all... chart all of that as having done it themselves (the nurses) and who knows what else. Where was/is management? Probably aware (most worked the floor before), but not wanting to see... nurses are hard to find, and if you make them work too hard (i.e., actually do all the work they are supposed to do themselves) they may just leave.
I refused to do any of these things; being called "slow" was one of the milder things that were said about me as a result. But I never compromised my personal and professional ethics. Was it hard? Oh, yes. I ran up OT ('cause I actually did the med and foot checks nurses were supposed to do) and management got on me for that - not that I enjoyed it!
What made me stay there so long (5 1/2 years)? The patients, and a few nice coworkers. I do miss my patients. But would I /could I return to such an environment? Absolutely, positively not.
I truly hope that this (which was happening at all local clinics, not just one) is the exception rather than the rule. I hope that most dialysis companies won't tolerate this unethical and illegal conduct. But I just wanted to let new nurses know that it may be happening and to protect themselves and their license. Please make sure you know your state law and what unlicensed personnel are allowed to do. Ask your manager, educator, ask more than one. Sadly, sometimes the fox truly guards the chicken coop- some of these unethical nurses do in fact move up to management. I have seen it. One of the managers in our area hadn't even passed nursing boards (yes, she lied about being an RN, but faked it well. A routine license check got her in the end.)
Personally, I wish our PCTs had been able to (legally) push heparin - it would have made my job a lot easier. As it was, I had to put on my own two patients and do all the assessments plus give heparin and lidocaine for 4-8 patients in the PCT sections (thankfully, there was usually only one PCT per RN; the LPN could of course give meds and assessments for his/her patients.) Add the dressing changes, tx meds, etc. - talk about stress! Especially during turnover
i do not know the laws in other states, but the company i work for has the policy that you can only draw up the hep/lido for the person they are putting on with time and initial. nothing can be pre-drawn. the techs can not access a cath, only an rn. we have no lpns-tho i know that other units have them. the techs can draw up hep/lido and they sign for it, if they are the person who starts treatment, also whomever initiates treatment are expected to "look, listen and feel" the access site prior to treatment--notify the rn of any abnormalities, saves a person with a clotted graft from being needlessly stuck. if time allows (HAHAHAHAHAH:rotfl: ), they can remove the cath dressing and change it, but very few do this, thats ok with me, i like to eyeball the site myself anyway. back in the day, we would pull up all the hep/lido for the next day, i am talking over a hundred hep syringes, but davita has changed that policy, now only the person who is initiating treatment can be the person drawing up thoses meds---let me tell you we all thought the world was coming to an end and we really fought the new policy--but now i love it. techs have never been allowed to pull up cath heparins--the labels are printed with our med labels(epo/zemp....). as far as saline, same thing goes, you pull it up as needed at chairside from the patients bag. the only exception i have ever seen is when we were under a tornado warning and i pulled up over 40 saline syringes from the same bag, in cases we had to remove patients from the machine. as far as pulling up extra hep in machine heparins, i always pull up extra, some dializers we push the extra hep and recirc----after pt is off, this is done to help with reuse. i hope this helps....read the policy, read the policy, and again read the policy on these matters. good luck to you!!!!!!!
....read the policy, read the policy, and again read the policy on these matters. good luck to you!!!!!!!
I can only second that - and if you see a discrepancy (P&P states x but you have observed y) take it up with your preceptor/educator/manager. Note how the question is received; if you notice any hesitancy at all, be very cautious (it may be wise to consider whether you are willing to work in a facility where state law is ignored by some or all. Remember: your license is at risk!)
In my clinic the policy is...whoever draws it up...gives it.
PCT's are not allowed to draw up any med...such as heparin or lidocaine.
They may draw up saline...at their pt chair from that bag.
Different states also have different rules. I'm in Tennessee but i think this is mostly a company policy. It makes sense to me tho & I agree with it. Makes me & my liscence more comfy. :redlight:
Not to be rude, but I would never in a million years EVER let ANYONE draw up a medication that I am supposed to be giving. PERIOD. I don't care if they have been doing it for 50 years and they could do it with their eyes closed...what are you guys thinking???? UNLICENSED staff drawing up medications?? Better think twice about that one....
I would just like to add one more thing....I noticed in some of the posts on this thread that people said "in our state, it is allowed under law that PCT's can draw up heparin, lidocaine, etc." Just because the law says PCT's can do it, doesn't mean they SHOULD do it. How irresponsible would that look if you are in court and you say "Um, I was just giving what my PCT drew up" Come on people....you earned the right to draw up and give your own meds. Just think about it....
Folks, only a licensed person, RN, LPN,etc can draw up medications, heparin, lidocaine, etc are medications. This seems to be a aspect we as professionals are sleeping on. Remember the person who administered the medication will be the one in court whether you drew it up or not. One of the first things in Nursing School was didn't draw,pour or open the pack then don't administer or sign your name. 
).
(yes, she lied about being an RN, but faked it well. A routine license check got her in the end.)
mossflower13
2 Posts
I don't understand why this is a question in so many units, I hear this all the time. I think if the higher ups give you a hard time about not following this dangerous practice then ask them for this policy in writing and if they hand it to you then make ten copies, send it to the health department and retire early