IV starts, blood draws

Specialties Private Duty

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How can a novice nurse get IV start and blood draw experience outside of the hospital setting?

Specializes in Complex pedi to LTC/SA & now a manager.

I don't disagree. I knew who you were responding to. Not all nurses in my agencies are permitted to do central line dressing changes...these nurses failed to demonstrate competency ( some by choice as they wanted only basic care) and are relegated to basic GT feed, PO/GT med cases.

The non oncology kids are peripheral sticks and thus restricted to lab corp & quest.

I know the infusion team draws of PICC/port and drops off at lab corp or quest as appropriate.

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Specializes in Pedi.
I don't disagree. I knew who you were responding to. Not all nurses in my agencies are permitted to do central line dressing changes...these nurses failed to demonstrate competency ( some by choice as they wanted only basic care) and are relegated to basic GT feed, PO/GT med cases.

The non oncology kids are peripheral sticks and thus restricted to lab corp & quest.

I know the infusion team draws of PICC/port and drops off at lab corp or quest as appropriate.

I certainly agree that not all nurses can or should do CVL care... but nurses assigned to TPN cases certainly should be competent in all aspects of line care, otherwise it's not an appropriate assignment for them. As a supervisor, I'm very careful about the nurses I send to patients with lines. And yes, I definitely know the type you're talking about who can't handle much more than the GT/seizure kids. It seems like, in my state, those kids don't qualify as much as they used to, though. I've referred many of my patients (who just get intermittent visits, this is the program I manage) to be evaluated and have been told immediately that they don't qualify. And some of them are definitely way more complex than some of the existing PDN patients we have though, who've had their services in place for years.

Anyway, back to the topic at hand, I imagine if I had a kid who needed TPN and my kid qualified for PDN and I got told "the nurse will come but you'll have to do everything yourself", I'd say "no thanks." Certainly there are agencies who are capable of providing nurses who can handle TPN/CVLs (your agency and mine) so I'm curious as to why a parent of a TPN dependent child would choose to get their hours through smartnurse's agency. Maybe there aren't as many options where she is, there's always another agency where I am if parents don't like the one they're with currently.

I don't use quest or any such place for any of my labs. I draw them myself and then drop them directly at the hospital. The peripheral stick kids it makes sense that they don't qualify to have a nurse do them. That's not really a skilled nursing need. I have one kid who I draw peripherally, but he also needs IM injections so that sort of justifies the skilled need.

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There is another agency that deals strictly with the Iv's. They come do the dressing changes,but that's it. They also do any teaching associated with the lines. She comes x2 a week and stays for an hr.The private duty nurse is responsible for the trach,gt,and vent.Around here,most agencies have that rule of no touching any Iv. Maxim wouldn't let me administer IV fluids because I wasn't certified.(even though I never would have known an Rn needs to be IV certified).

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I should clarify more.If the kid only needed Tpn,then of course the Pdn wouldn't be there.If the kid has Tpn,and say a gt,then the Pdn only deals with the gtube. Its Still hands off!

In my state,lpn's are not allowed to do anything at all with Iv's.

They can't change Gtubes either.

Most of the kids I have seen on tpn in this area have trachs and vents too. Blood draws are done by the same company that does the dressing changes.

Now,most of the Iv infusion agencies don't have nurses trained to work with vents and trachs.

I've spoken with a few Iv nurses when they visited and that's what they told me.

So it seems that the kids with vents and cl always are going to need 2 agencies in the home.

I guess we in Nj are spoiled!

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Specializes in Complex pedi to LTC/SA & now a manager.
I should clarify more.If the kid only needed Tpnthen of course the Pdn wouldn't be there.If the kid has Tpn,and say a gt,then the Pdn only deals with the gb. Still hands off!In my state,lpn's are not allowed to do anything at all with Iv's.[/quote']

You stated you are in NJ, NJ BoN does permit LPNs to work with IVs just no IV push, port-a-cath access, chemo admin, or blood administration. It is within the LPN scope of practice. This has been in the NPA for quite a few years now. Back in late 90's it was no IVs for LPNs but not anymore Employers can be more restrictive for RN or LPN scope of practice just not more permissive

There are many agencies in my area that do offer both PDN & high tech infusion so as to not duplicate services. PDN agency isn't paid for the hour(s) a skilled visit is performed by a second agency when PDN is there per federal guidelines. Just like skilled nursing intermittent is not billable if the patient has an MD follow up appointment. Payers are cracking down on double billing.

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I worked a case one time where a nurse from another agency came to do the IV antibiotic administration. The parents questioned this because they had a big problem with the demonstrated competency of the IV nurse. All other care on the 485 was the responsibility of our agency nurses. We were told we had to chart on the condition of the IV line but that was all. Seemed like a waste of duplicated fees to me.

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Specializes in Pedi.
You stated you are in NJ, NJ BoN does permit LPNs to work with IVs just no IV push, port-a-cath access, chemo admin, or blood administration. It is within the LPN scope of practice. This has been in the NPA for quite a few years now. Back in late 90's it was no IVs for LPNs but not anymore Employers can be more restrictive for RN or LPN scope of practice just not more permissive

There are many agencies in my area that do offer both PDN & high tech infusion so as to not duplicate services. PDN agency isn't paid for the hour(s) a skilled visit is performed by a second agency when PDN is there per federal guidelines. Just like skilled nursing intermittent is not billable if the patient has an MD follow up appointment. Payers are cracking down on double billing.

Precisely. You can't bill for skilled nursing visits during the same time as PDN hours. I don't think you even can on the same day. If there's already a nurse working a shift in the home, it makes no sense from a practical or insurance standpoint to bring in another nurse for a short visit. For all the PDN patients in my agency who have lines, their PDN does the line care. And yes there are children who qualify solely on the basis of needing TPN- with no trachs, vents or G-tubes.

Re: the MD appointment thing. I've done many visits on the same day as MD appointments and have not had an issue with billing. Not all MDs can provide the service the child needs. For example, if a child with cancer needs chemotherapy or her port accessed for labs but has a follow-up appointment with her gastroenterologist, the MD certainly isn't going to be doing either of those things.

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Specializes in Complex pedi to LTC/SA & now a manager.

If I recall correctly it's a follow up visit with the "treating doctor" for the condition that qualified for skilled nursing visits, so an oncology patient visits the oncology clinic, no skilled visit that date. Oncology patient visits the GI, can have both...

A new GT that has skilled nursing for parent education & assessment, visiting the pedi for a routine check up skilled visit fine. Visiting surgeon or GI clinic, duplication of services.

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Wow,things are different!I was told by numerous agencies that Lpn's aren't allowed to touch any IV's,and that's the BON rule.The Lpn schools don't teach IV skills either;my school back in 2002 told us this,and from asking around,that's how its been for years.As far as duplicate services,I have seen the Iv nurses in the home,while I was doing Pdn and nobody ever said anything about "duplicate services".Same with Doctor visits. The agencies have always paid that. From what a nursing supervisor told me,if you leave while a pt is at a Doctor visit,and something happens(or even if it doesn't) that's considered Pt abandonment,and that's a serious charge. Your hours are scheduled,and you have to be with the pt at all times.

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Specializes in Complex pedi to LTC/SA & now a manager.

The doctor visit refers to skilled intermittent visits (traditional home health) not a private duty nurse who accompanies a patient to a physician appointment.

Duplication of skilled nursing visits is taken very seriously by insurance companies whether IV nurse visiting during a PDN shift, two agencies or two nurses overlapping shifts. The insurance company won't pay for both.

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I guess this depends on the state.When a child needs transport to a Doctor's appointment,there has to be a Critical care Rn with the transport company picking him up and dropping him off. They also have to wait with him at appointments. It doesn't matter if he has an appointment for 2 hrs,they must stay at the clinic.It doesn't matter if an RN is going with the pt and his parent.

If they leave and something happens,it is considered abandonment.

I have asked the CC nurse why the pt needed a CC nurse when she already has her own Pdn,and she said that I don't have the meds to start her heart up in an emergency,like Atropine and epinephrine. Of course we always bring theGobag,Ambubag,emergency sx machine, and back up vent and batteries, but I could always do chest compressions. She says time is of essence.The flight nurse also has 3 EMT's with her on the ambulance,and they use their own 02 and pulse oximeter.

Its a bit of overkill if you ask me,but the part about the heart meds is true. She goes to school with nothing but a Pdn nurse,so why are Dr appointments different?

The state of Nj is very,very strict.

Not to sound silly,but I believe that could be a reason why many nurses in Pdn in Nj are"behind" in skills.Throw in Ltc too,as I was told the same thing while an lpn there;we could touch any IV's.

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The doctor visit refers to skilled intermittent visits (traditional home health) not a private duty nurse who accompanies a patient to a physician appointment. Duplication of skilled nursing visits is taken very seriously by insurance companies whether IV nurse visiting during a PDN shift, two agencies or two nurses overlapping shifts. The insurance company won't pay for both.
The IV nurse comes during the day,while I'm still there.its been going on for a yr,and nobody in billing from my agency hasn't said anything. I wonder how Nj is able to get around so many rules? From what I know,Nj is more generous as far as Pdn is concerned.
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