Not learning to place central lines

[AmiK25]

I have a question for current SRNA's and CRNA's. I attended an informational session at my number one choice anesthesia school last night and I was told that the SRNA's place many art lines, but do not get experience placing central lines or PA lines. In fact, it is against policy at the university hospital with which the school is associated for CRNA's to place central lines. Here is my question...how important do you think it is for students to gain experience placing lines. Of course I would like to be taught all procedures that will be within my scope of practice as a CRNA but do you think it is important enough to go with my second choice school (which is much more expensive and much farther away from our families...I have a stepson that we will still need to see every other weekend so we will have to come back here to pick him up and my number two school adds 3 hours to the drive)! If you are not exposed to central line insertion in school, would a facility be willing to train you at a later time? How common is it that you actually insert central lines? The representative from this particular program did not seem to think it was a big deal that they do not allow students to place lines! It seems to me that I should know how to insert a central line, particularly if I will be in a more rural area without much backup/support. What do you all think?

Thanks,

Ami

[alansmith52]

I have had questions about this also. It seems that the answer depends on who I talk to.

If I asked a school whose primary clinical site was at an institution that did't not allow CRNA to get the venous access experince. (and this I think is a turff type battle) then they would answer by telliing me "its no big deal, if you need to know how to do that later its easy to learn or a group will teach you".

on the other hand if you ask a school whose students are doing it. They are of the ilk that it is importat.

personally I think its true that we could learn later if we dont get it in school but we should also be wary of desisitazation to our skills being taken away.

in other words. if you give em an inch...

[pinayrn95]

I have had questions about this also. It seems that the answer depends on who I talk to.

If I asked a school whose primary clinical site was at an institution that did't not allow CRNA to get the venous access experince. (and this I think is a turff type battle) then they would answer by telliing me "its no big deal, if you need to know how to do that later its easy to learn or a group will teach you".

on the other hand if you ask a school whose students are doing it. They are of the ilk that it is importat.

personally I think its true that we could learn later if we dont get it in school but we should also be wary of desisitazation to our skills being taken away.

in other words. if you give em an inch...

I think they are more worried of complications that may arise from it, and how you manage it- pneumothorax, hemothorax then chest tube insertion. In our facility CRNA do the CABG but MDA insert central line. Thats my 2 cents. I was just like you worrying about your scope of practice. Surgeons just have a different scope of practice as CRNA. The complication of putting it in is enormous and thats why surgeons prefer MDA to insert central lines. I am not so sure of others.

[Athlein1]

It's not that important to get this experience in school. If you go to a place that allows CRNA to place their own lines, then that place will teach you (same goes for regionals and blocks, really). A motor skill is relatively easier to teach (and acquire) than a thinking skill.

It's far more important that you attend a program with a strong didactic foundation and solid, broad clinical experience.

[BikeGurl]

It's funny when you think of the residents in the ICUs that haven't even started an IV before jabbing at patients necks to start an IJ or SC. I know that the risks of pneumo are high, but I think it's odd that they don't train CRNAs at a lot of schools to put central lines in. Is there any other reason?

[Passin' Gas]

Council on Accreditation of Nurse Anesthesia Programs: Standards for Accreditation of Nurse Anesthesia Education Programs, Jan 2004 requires a minimum of 5 central line placements, preferred number of placements is 10. These (for now) can be either simulated or actually placed in a patient. Perhaps you should ask how these requirements will be met.

PG

[AmiK25]

Thank you Passin Gas...I absolutely will ask. When I asked about it last night, the assistant director said that at the university hospital, SRNA's/CRNA's do not place lines at all (except a-lines). He said he did not know if there was an opportunity for central line placement during the open heart rotation but he did not think so! I will definitely find out before I make my decision regarding which school to attend (which might not even be a decision b/c I would have to be accepted to both)!

[Brenna's Dad]

I agree with what Athlien has said to some degree. But, I also believe that schools should be educating CRNAs to be independent practitioners. Part of being a general practitioner is placing all types of lines.

As far as the complications, yes, they are many. But this rationale does not stop residents from placing lines and it should also not stop SRNAs from placing lines. If you get a pneumo, you should know how to needle the chest. If you get a carotid tap, hold pressure.

This is all about turf in my opinion. CRNAs need to defend theirs.

[Passin' Gas]

I agree with what Athlien has said to some degree. But, I also believe that schools should be educating CRNAs to be independent practitioners. Part of being a general practitioner is placing all types of lines.

As far as the complications, yes, they are many. But this rationale does not stop residents from placing lines and it should also not stop SRNAs from placing lines. If you get a pneumo, you should know how to needle the chest. If you get a carotid tap, hold pressure.

This is all about turf in my opinion. CRNAs need to defend theirs.

Amen.

PG