Invasive Lines

[alansmith52]

so i had a yearly evaluation with my manager. i mentioned in a previous post that i was getting the feeling that he was among the ranks of rn's who are bitter towards crna's. this is a sticky situation because i plan on getting refrences from him this summer.

so we where talkin about crna's and i mentioned that i was glad we had so many swan ganz patients latley as i need to be more profcient at my hemodynamic montoring and iterpretation. he started saying "well i know crna's need to be able to "fiddle" with that stuff but i know they don't place any of those kind of lines.....

hmmmm i thought; i didn't say anything i just nodded my head.

don't crna's place invasive lines????

i thought that maybe due to fact that it is a teaching hospital that they don't so the residents get some experince at it. for example in my icu the rn's don't pull femoral sheaths just so residents get the feel.

i hope that crna's do subclavian lines, swans, art lines and ij's

matt.

[lgcv]

This is from the AANA website

CRNA scope of practice includes, but is not limited to the following:

Performing and documenting a pre-anesthetic assessment and evaluation of the patient, including requesting consultations and diagnostic studies; selecting, obtaining, ordering, and administering pre-anesthetic medications and fluids; and obtaining informed consent for anesthesia.

Developing and implementing an anesthetic plan.

Initiating the anesthetic technique which may include: general, regional, local, and sedation.

Selecting, applying, and inserting appropriate non-invasive and invasive monitoring modalities for continuous evaluation of the patient's physical status.

Selecting, obtaining, and administering the anesthetics, adjuvant and accessory drugs, and fluids necessary to manage the anesthetic.

Managing a patient's airway and pulmonary status using current practice modalities.

Facilitating emergence and recovery from anesthesia by selecting, obtaining, ordering and administering medications, fluids, and ventilatory support.

Discharging the patient from a post-anesthesia care area and providing post-anesthesia follow-up evaluation and care.

Implementing acute and chronic pain management modalities.

Responding to emergency situations by providing air-way management, administration of emergency fluids and drugs, and using basic or advanced cardiac life support techniques.

Additional nurse anesthesia responsibilities which are within the expertise of the individual CRNA include:

Administration/management: scheduling, material and supply management, supervision of staff, students or ancillary personnel, development of policies and procedures, fiscal management, performance evaluations, preventative maintenance, billing and data manage- nt.

Quality assessment: data collection, reporting mechanism, trending, compliance, committee meetings, departmental review, problem focused studies, problem solving, interventions, documents and process over- sight.

Educational: clinical and didactic teaching, BCLS/ ACLS instruction, inservice commitment, EMT training, supervision of residents, and facility continuing education.

Research: conducting and participating in departmental, hospital-wide, and university-sponsored research projects.

Committee appointments: assignment to committees, committee responsibilities, and co-ordination of committee activities.

Interdepartmental liaison: interface with other departments such as nursing, surgery, obstetrics, post-anesthesia care units (PACU), outpatient surgery, admissions, administration, laboratory, pharmacy, etc.

Clinical/administrative oversight of other departments: respiratory therapy, PACU, operating room, surgical intensive care unit (SICU), pain clinics, etc.

The functions listed above are a summary of CRNA clinical practice and are not intended to be all-inclusive. A more specific list of CRNA functions and practice parameters is detailed in the AANA Guidelines for Clinical Privileges.

[lgcv]

Here is the website:

http://www.aana.com/crna/prof/scope.asp

[etherbunny]

Matt,

CRNA's most definitely place central lines, pa catheters, a-lines etc. I will admit that there are hospitals that try to restrict this practice. It has been my experience that it is mainly the anesthesiologist trying to seperate themselves from the CRNA. To prove to others they posses some skill that we don't.

When applying to anesthesia school, make sure you interview the school as well. Get a good idea of whether or not they are going to provide you with adequate training in that area.

When I graduated from anesthesia school, I walked into my first job with ample skill to place central lines, arterial lines etc.. These are technical skills that do not take a medical degree to learn. In fact PA's often place these types of lines as well.