I'm an LPN, so I do not know a whole lot about Picc lines, central lines, etc. I'm only familiar with you basic INT. In my state we don't even get to learn about them, much less do anything with them. Well my question is, I had a new admit at a rehab facility that I work in. He was brought there to ultimately pass due to d/c'ing his dialysis. He had a AV shunt in his left forearm that was never used, I'm assuming because of the acuity of his renal failure, it had not healed yet so they put in a IJ. Okay, I've looked this up and I'm confused. I know it's intrajugular, with a V on one lumen and a A on the other, I can figure that out. But my question is, the resident had a CVA appx 1 month ago and is completely agitated while awake. He took off his O2, attempted to pull out his one week old peg tube and grabbed his IJ port and managed to pull a stitch lose. I contacted the doctor to get an order for something for anxiety/agitation, since I really didn't want this guy pulling anything out, especially the IJ port. Well when the doctor gave me the orders, he said to give Ativan IV. Well I know I'm not allowed to due to LPN's scope of practice, but my gut told me that maybe this port was not for use of administering medications, but just for dialysis. So I apologized to the doctor of my ignorance to this type of site and asked for an order for IM or peg tube adminstration of Ativan. He agreed, but in the interim I felt like an incompetent idiot. I'm actually pretty intelligent, but I'd never been exposed to any other access for dialysis other than an AV shunt or AV fistula. So is this something I should of known, or am I an idiot? I've been researching all evening and have come up with nothing. I know you can give meds through a PICC, a CVC, a INT, but the IJ port confused me. Please be kind in your responses. I know as nurses whether it be a LPN or RN, we don't know it all, but when you have to admit it especially to a MD, you kind of feel like a moron. And we do have RN's in house all the time and they to said you couldn't use it for medication administration, but they also have worked LTC with little to no acuity since graduation, so I don't know if it's a case of it you don't use it, you lose it, or they were never subjected to this in school or at their clinicals. Any clarification would be wonderful. There are not to many times that I wish I had my RN, but knowledge is power and I felt pretty powerless the other night. I think about getting my RN to know more, but along with that comes more responsibility and I'm not sure I'm ready for that. Please be nice with your responses, I don't want to be made to feel like less of a nurse, but that its okay to not know everything and be able to admit it and to not feel like an idiot. Thanks in advance....
