How often do you do nerve blocks and PA Cath insertions?

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So I just interviewed at a CRNA DNP program and during the process they told me that while we will do a semester rotation at a rural hospital doing spinal blocks and PA Cath insertions we wouldn't do it often in practice. In fact they said at their university hospital and many other facilities the CRNA's don't put in CVL's, PA Caths and nerve blocks.

I've heard that some programs don't focus much on these skills at all. Did your program train you how to do these skills well and how often in your professional practice do you perform these skills.

Also if it's not common for a CRNA to be proficient in these clinical skills would that be a bargaining chip for higher pay when searching for employment?

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I put in a cv cath a couple times but was supervised. Hospital where i worked at and also the one i am at now doesn't allow anybody but physicians to put them in without supervision. You sort of answered your own question though, if MOST facilities do not allow CRNA to put them in it probably would not be a bargaining chip. There are plenty of surgeons and pulm/ccs to put lines in so they may not be willing to down play it to a crna.

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"Downplay it" would be a foolish and uninformed way to look at it. I'm not sure what type of experience you have giving you such a limited and skewed view of the medical field (phlebotomy, nurses aide?) but as an ICU RN I assist first hand in line placement. Who we always have on call as our backup if the RN can't get peripheral and MD can't get the CVL is "Anesthesia". They are the calvary when nobody else can do the job. You might even call it their specialty. lol.

Are there any CRNA's here who have some helpful or informed input?

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Hey don't be mad at me its administration and the docs that make the call. Im just telling how it is. Don't ask a question if you don't like the answer. None of my buds who are CRNAs place that many lines, if they do its in the or with surgeon there. By anesthesia they mean MDA, not CRNA. If you assist first hand you should already know who puts them in, and by the sounds of it its the docs at your facility. If you are into putting lines and stuff in you may want to go be a doctor. I mean a real doctor of medicine.

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Hey don't be mad at me its administration and the docs that make the call. Im just telling how it is. Don't ask a question if you don't like the answer. None of my buds who are CRNAs place that many lines, if they do its in the or with surgeon there. By anesthesia they mean MDA, not CRNA. If you assist first hand you should already know who puts them in, and by the sounds of it its the docs at your facility. If you are into putting lines and stuff in you may want to go be a doctor. I mean a real doctor of medicine.

Another ridiculous and uniformed opinion of a layperson. When we call for anesthesia the person who responds is who is available and not in a case, MDA or CRNA. I'm a travel nurse so when I'm in a teaching facility the residents eager to get some training will always attempt a CVL first. They often miss or get nervous when they mess up and we call for backup. When I'm working outside of teaching facilities your Nephrologist will insert their Vascaths for acute temporary dialysis. If your pulmonoligist is available and wants to he can insert a CVL. If that isn't possible then we call yet again, Anesthesia.

Of course I'm not asking about bedside ICU line insertions. I'm asking specifically practicing CRNA's from their experience what type of facilities they work and what is the common practice for line insertions and nerve blocks.

I will be trained on these things and get practice doing them while in school so I'm curious about employment after.

I've worked at hospitals where RN's could not put in NG tubes unless they were ICU RN's. I've worked hospitals where peripheral IV's were to be inserted only by the RN's on the IV Team. Surely Sauce you don't believe that these RN's are not expected to be proficient in these skills when they seek a different employer.

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It isn't our decision though. You and I probably do not agree on everything, but I do think (surprisingly) that CRNAs should be able to place more lines than they do. But it isn't up to you or I, it is administration. But from my experience at many hospitals they do not let them place them often or at all in some places. If you want any time at all placing lines as a CRNA and would like to dodge administrative roadblocks, of the people I know, small rural facilities are you best shot. Some of the peripheral hospitals in my area even let NPs place lines if no doc is available. Most procedural stuff, whether we like it or not, will be held onto tightly by the MDs, because it bills for a lot.

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Specializes in Anesthesia.
So I just interviewed at a CRNA DNP program and during the process they told me that while we will do a semester rotation at a rural hospital doing spinal blocks and PA Cath insertions we wouldn't do it often in practice. In fact they said at their university hospital and many other facilities the CRNA's don't put in CVL's, PA Caths and nerve blocks.

I've heard that some programs don't focus much on these skills at all. Did your program train you how to do these skills well and how often in your professional practice do you perform these skills.

Also if it's not common for a CRNA to be proficient in these clinical skills would that be a bargaining chip for higher pay when searching for employment?

There are a lot of CRNAs that do PNBs and CVLs as part their routine practice. PA catheters are generally left to whoever is in the CV OR often times it is an MDA but sometimes it is a CRNA.

It comes down to money and politics. Some MDAs try to limit SRNAs/CRNAs training so they don't have exposure to doing PNBs or CVLs thus ensuring job security. There are approximately 65% of anesthesia practices that use a "supervision" model and most of those will not allow their CRNAs to CVLs and PNBs.

You can learn to do these things after becoming a CRNA, but it will be harder to find an anesthesia group that is willing to spend the time getting you oriented and trained.

I trained in a military program so we exceeded all the recommended clinical numbers, and I did one month each of regional, OB, CV, and peds.

There are some higher paying CRNA jobs that include solo and independent practice where you need to be proficient in regional, spinals/epidurals/OB, and CVLs to even be considered for the job.

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Specializes in Anesthesia.
Hey don't be mad at me its administration and the docs that make the call. Im just telling how it is. Don't ask a question if you don't like the answer. None of my buds who are CRNAs place that many lines, if they do its in the or with surgeon there. By anesthesia they mean MDA, not CRNA. If you assist first hand you should already know who puts them in, and by the sounds of it its the docs at your facility. If you are into putting lines and stuff in you may want to go be a doctor. I mean a real doctor of medicine.

Sauce NP, just because your facility works this way does not make it representative of all anesthesia practices with CRNAs in them. All SRNAs are required to learn how to do CVLs, but some anesthesia schools will only expose CRNAs to the absolute minimum. That doesn't mean that the vast majority of CRNAs are not qualified to independently insert CVLs.

CRNAs have the choice where they work. CRNAs can choose one of the restrictive anesthesia environments where the MDAs do all the lines and blocks or they can choose to work in an independent practice. The ability to choose is severely limited if those CRNAs do not go to nurse anesthesia school that provides enough exposure to independent practice and CVLs/PNBs.

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It is very important for a student to get a good base level of skill with nerve blocks and using the ultrasound. Regional anesthesia, especially with ortho, is quickly becoming the standard. Skill in placing the five or six most common blocks is very important coming out of school.

Central lines are not nearly as important. Nice skill to have for sure, especially as one gets more familiar with the ultrasound and seeing the needle tip, but they are getting placed less and less each year. Swan-Lines are almost irrelevant. The advent of non-invasive monitors as well as adjuncts like the Vigeleo as well as Echo and TEE have rendered them almost worthless. Many of our open hearts dont even get them anymore.

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Specializes in Anesthesia.

One of my favorite books Resource for Nurse Anesthesia Educators: 9780970027962: Amazon.com: Books discusses how a technical skill like regional anesthesia takes 15 on average to become competent and 50 to become proficient. This was based on a study done in MDA residency programs.

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Wow, great input, just what I was looking for. The program said they do an entire semester rotation in a rural hospital where you do lots of CVL's and PNB, some PA Cath's. I'll use that semester to try my best to become proficient with them all. I'll probably seek employment from the 1/3 of practices that allow full use of CRNA skill so I don't get rusty. Thanks guys.

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Specializes in Nephrology, Cardiology, ER, ICU.

Ok playing devils advocate here, why would rural hospitals place lines when most often the pt would be transferred to a tertiary center?

I have been an APRN for 9+ years. The rural hospitals transfer all or most all "sick" ICU pts.

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