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

[Bluebolt]

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?

[wtbcrna, MSN, DNP, CRNA]

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.

CVLs, especially at smaller places, are still placed quite often for IV access d/t difficult IV stick. Also, just because the "sickest" patients are transfered doesn't mean there still isn't a small amount of relatively sick patients that do not need CVL access in the step down/ICU at these rural hospitals.

CVLs are one of those bread and butter skills that CRNAs need to know how to do when working independently.

[Bluebolt]

The term rural hospital is a relative term. I worked at a "rural" hospital that did CABG's, complex heart cath, CRRT and IABP. I'd say 60% to 70% of their 23 bed ICU had CVL's, all the CABG's had PA cath's, etc. The nearest big city hospital was in Atlanta which was an hour away.

I worked a 14 bed MICU/SICU in a small 200 bed hospital in rural Georgia, probably 30% had CVL's, no PA caths or IABP.

Hopefully that helps answer your question traumaRUs.

[traumaRUs, MSN, APRN]

Yep that helps. I'm in the Midwest where rural means hospitals with 50 beds total, some critical access hospitals have 10-15 beds

[PMFB-RN, RN]

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.

This is usually the case in rural hospitals where I live too, except in winter we often have days where the helicopter can't fly due to weather conditions and ground transport takes hours. This means that our rural hospitals end up caring for some very sick people for a lot longer than they would like to.

FWIW in my main job at a community teaching hospital all lines (outside the OR and IR and except for PICCs) are placed by residents, often with CRNAs teaching or supervising.

In the rural hospital where I work part time there is no PICC nurse and all lines are placed by the CRNA.

When I say rural I am talking about critical access hospitals with

[traumaRUs, MSN, APRN]

Yes, that is what I mean rural also. However, the one hospital where I almost took a job as a hospitalist was 75 miles from any hospital of any size, they had 25 beds, 4 ICU beds and there monitoring equipment was very limited. I truly was looking to this position to broaden my skill-set but found out that they had two vents in the entire ICU and if/when they placed even a CVL, it was a rare event. Since they didn't perform dialysis, temp HD caths weren't used and more invasive monitoring just wasn't available.

[Bluebolt]

Yes, that is what I mean rural also. However, the one hospital where I almost took a job as a hospitalist was 75 miles from any hospital of any size, they had 25 beds, 4 ICU beds and there monitoring equipment was very limited. I truly was looking to this position to broaden my skill-set but found out that they had two vents in the entire ICU and if/when they placed even a CVL, it was a rare event. Since they didn't perform dialysis, temp HD caths weren't used and more invasive monitoring just wasn't available.

I've never worked at a facility like this but know of a friend who worked PRN at one. In the ED they didn't even have RT's or PCA's it was just a couple RN's and one MD, outdated machinery, etc. That's a level of rural that is far beyond what I'm comfortable with.

I guess if I was doing a mission trip to Honduras I'd end up in an environment like that.

[wtbcrna, MSN, DNP, CRNA]

The smallest hospital I have worked at was on an island in Alaska. There 4-5 hospital beds and 10 or so nursing home beds. The OR only opened when they could get a surgeon and anesthesia to fly in every couple of months or so.

[traumaRUs, MSN, APRN]

@wtbcrna. I lived in Alaska for a couple of years at ft Greeley, delta junction. No civilian hospital just a military clinic and if dust off couldn't come down from Fairbanks we were IT

[traumaRUs, MSN, APRN]

@bluebolt I live in a rural area but as I have travelled extensively and lived overseas for 10 years in three different countries comparing rural IL to a medical missions trip in Honduras kinda proves my point that you may not be as well educated in all aspects of medical care as you profess to be

[Bluebolt]

@bluebolt I live in a rural area but as I have travelled extensively and lived overseas for 10 years in three different countries comparing rural IL to a medical missions trip in Honduras kinda proves my point that you may not be as well educated in all aspects of medical care as you profess to be

Actually I've been to Honduras, obviously it was hyperbole. If you are so well traveled and experienced then you should have already known that rural facilities are typically not 50 beds or less with no CVL placement.

Don't draw such a substantial conclusion based off one sentence in a single post, it doesn't reflect well on your logic.

[Bluebolt]

To redirect the thread back onto the topic, if any other CRNA's have input from their experience with PNB's, CVL's, and PA caths I'd appreciate it.

Any others can feel free to chime in as they seem to do, it is America, but that isn't the purpose of my thread.

[WhiffOfGas]

Throwing in my two cents of observation because I'm interested in the responses too:

The CRNA phone is the one we call when we need a central line in the unit (20bed) -and that's fairly often. When I worked as a PACU tech, a lot of the patients had PNBs done by the CRNAs back in the OR. It was my understanding that, if they couldn't get it -or weren't comfortable- one of the MDAs would do it. PA caths are typically done by the docs (or this has been my observation), but it could be because we just don't have/do a lot here. Overall, our CRNAs pretty much do everything! They're our anesthesia on-call, and there isn't always an MDA in house. They're amazing individuals!!

I work in a suburban facility (100 beds), so it may not be particularly insightful. But... I thought I would offer up my observation anyway.