IABP Removal

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I wanted to post a question to the board and get a feel for what is being done in other institutions. I work in busy CCU unit. We routinely care for IABP patients. We have a new cardiologist on staff who thinks that the bedside nurse should D/C the IABP's when ordered without a physcian present or potentialy even in house . Currently our policy is to have a physcian D/C pumps. Our nurses do have a lot of autonomy, more than any other CCU I've been in. So I'm wondering if this is common practice in other CCU's or if we are getting into murky waters. Thanks for your input.

Specializes in CTICU.
Congrats on the things you can do in the OR as well as the ICU. In the 12 years of doing this same job - I have never seen a complication from the IABP. And as far as my concern for patient safety, It is my first priority :up:. ( which has nothing to do with a License or Certificate) That is why I don't mind doing the things that RNs choose not to. Good thing I'm credentialed to do so :smokin:. Yeah , I know it makes some :nurse:s really :madface:, but its the nature of the game. Ill continue my same job as soon as I graduate from PA school - Can I pull it then without jepardizing patient safety?

When you have a license, yes you are less of a danger to patients because you have a certain level of education and training associated with it.

If you genuinely think that nurses are mad because you are credentialled to do things they don't want to do, then you are most likely mistaken. They DON'T WANT to do them.

Finally, as someone who specializes in mechanical support devices, I can say if you have really "never seen a complication from the IABP", then you obviously haven't seen many IABPs.

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Specializes in CT ICU, OR, Orthopedic.

actually, unless you have not provided all of your "credentials", it is out of your scope of practice. According to the NSAA, an SA (it does not indicate RN or ST) assists the surgeon during surgical procedures under the direct supervision of the surgeon. They are not even supposed to leave the room while you close... Obviously that is never going to happen, they leave all the time...

I am all for the rights of CSTs, and I think they need more respect and responsibility.. It was my job for 10 years, before graduating as an RN. I had an Associate of applied science, just like the ADNs have. I think they are qualified to circulate (I recently started circulating, and it does not need to be an RN, but in most hospitals, it must be an RN) and FA (we just recently started hiring CSTFAs).

When you graduated as a PA, then you will be a MLP, and yes, pull what you will, in the mean time, I hardly doubt you would be covered by the hospital if you got sued if something went wrong. I doubt your insurance plan would cover you either bc it is out of your scope.

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Specializes in ICU, CCU, CVRU, little peds.

BEDSIDE RN's (CCU) always pull them without an MD present if its at night the mds that deal with iabp are not even in house... never had a problem (matter of fact pulled one last night)

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At my hospital, the MD pulls the IAB and we use the FemoStop. We then treat it as a usual sheath removal (FemoStop on for about an hour, then wedge pressure dressing on for 6 hours).

There are many things that can happen during the dc of an IAB (like entrapment). It is just good and safe practice for the MD to pull the IAB.

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Specializes in ICU, CCU, CVRU, little peds.

We (RN's) on our unit pull the IABP, the md is not even required to be in house. This has been done like this for many years. It is with in the scope of the RN as long as they have been signed off on it (atleast in the state of NC) We have never had problems. We do not use femstops often (try not to) Best Practice states manual pressure is best, it has the lowest complication rate. When a femstop is place on the RN tends to not watch the site for the entire 20-30min and when they go back after 5 min the patient has had complications. Manual pressure always best. (i have the lit to back this up if you would like it)

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Specializes in Critical Care.

I have worked in several different ICU settings and and at no point is a nurse allowed to pull a IABP. I guess it comes down to the hospital policy because in the end that is what is going to cover the nurse. If policy says no then you can't do it.

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Specializes in ICU,cardiothorasic and CCU.

In our CCU, nurses are not allowed to d/c or remove IABP, the only thing we're allowed is to reduced the frequency of IABP from 1:1- 1:3 and nothing more than that. I think what happening now is some of the doctor are pretty much dependent to nurses. We should not tolerate this and we should always questioned doctors regarding this matter and in fact this is not included in our scope of practice or not even a nurses extended role.

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Specializes in ICU,CCU, MICU, SICU, CVICU, CTSICU,ER.

Our hospital has perfusionists that D/C the IABP's. RN's should not be doing this- the potential for complications is too high. I feel that those who have posted that they have D/C'd IABP have done so without fully appreciating the risks of liability they have undertaken. This is a physician, PA, or perfusionists' responsibility. In a court of law you may be liable because you could be acting outside of the scope of practice for the RN (check your state nursing boards for specific regulations). In my experience, physicians are eager to D/C a pump so they can clear the ICU or cath lab board early and go home...too bad! Stay and finish the job, and quit dumping more unnecessary tasks on nursing!:angryfire

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Specializes in ICU,CCU, MICU, SICU, CVICU, CTSICU,ER.
In our CCU, nurses are not allowed to d/c or remove IABP, the only thing we're allowed is to reduced the frequency of IABP from 1:1- 1:3 and nothing more than that. I think what happening now is some of the doctor are pretty much dependent to nurses. We should not tolerate this and we should always questioned doctors regarding this matter and in fact this is not included in our scope of practice or not even a nurses extended role.

We were expected to trial wean some patients and shoot numbers for Doc A and B, but don't dare do it for Doc C or Ds patients. Some would want to give the order to wean verbally, not that they looked at the patient first, and others would expect the IABP to be weaned by the time they came on the unit at 10 ish AM...my point is that we cater to physicians far too much in this profession to where, as nurses, we have what I call dilusional autonomy. It angers me to hear that there are nurses out there that do the bidding of physicians so they can cut out early while we are left holding the bag...in this case a fem pressure drsg. I don't even ask docs what they want for procedures anymore-they know where the supply racks are located..and if they don't their PA surely does! Lets go nurses, stop acting outside of the scope of your practice just to hope for a little respect that you may (not) get. Docs may say thanks-but will they remember on the next shift? Ok...I'm done, I really needed to do that!:twocents:

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CCRNCCU2008, I would love to have the reference for your literature you cited. This is an interesting topic.

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