Nurses cant do IO?

[blackvans1234]

Hey all, just wondering what everyone thinks of this.

My facility (magnet) does not let nurses perform Intraosseous injections. It is to only be done by a physician, even in a code situation. I cannot speak for our ED, but this is the policy within the hospital. The state nurse practice act says we are allowed to...

I was just told today that the IO drills are being added to our code carts..

I guess you can say im a little jaded that the state says we can do it but the hospital reduces our scope of practice. Im almost certain they review it in ACLS.

This annoys me, especially when Magnet facilities claim to be all about their nurses, communication with their nurses and listening to their nurses.

I often wonder if teaching hospitals places such restrictions on their nurses...

[BR157]

Im almost certain they review it in ACLS.

This annoys me, especially when Magnet facilities claim to be all about their nurses, communication with their nurses and listening to their nurses.

...

ACLS does not certify or even train you to do much. The course is pretty much a joke today.

It is more annoying and dangerous for someone who believes they can do ACLS procedures (IOs, Central lines, and intubation) after taking an ACLS class.

If there is a need for an IO to be used in your facility, there will probably be people on your code or rapid response team who are properly trained.

Once the IO is placed, it is then used like an IV. I doubt if there will be restrictions on RNs giving meds and fluids through it.

Hospitals usually prefer central lines and usually have an NP, PA or MD around who can insert them quickly.

[icuRNmaggie, BSN, RN]

Check your nurse practice act. Look up LMAs and IOs. These things are taught in ACLS so that you can become familiar and assist the MD by pulling the correct size.

[guest769224]

I work in a teaching hospital level 1, and I witnessed two IO's go in last week in our ICU by the RNs.

[icuRNmaggie, BSN, RN]

My state also will not allow RNs to place a dobhoff either whereas many other states do.

[klone, MSN, RN]

There are some really cool Youtube videos of IOs being placed on volunteers. They claimed it didn't hurt any worse than a PIV placement (although I've heard that the fluids going in hurts like an SOB).

[ScrappytheCoco]

I have placed 2-3 in the ED, we don't use them often since the physicians are close by to place a central line. If they're in that bad of a way EMS has usually already done the IO placement in the field. Do your patients generally have a PIV on admission? If so I wouldn't fret about it. They didn't even teach us anything about IO access in ACLS. I recall learning to place them in PALS.

[Altra, BSN, RN]

ACLS does teach IO insertion, and has for about a decade. Your facility does reserve the right, however, to enact a policy that specifies that only physicians can perform this ... even though it's an asinine policy.

[GrannyRRT]

I have taken ACLS classes for over 30 years which includes back when the certification actually meant something. On page 70 in the text there is a paragraph about IO. On the website there is a short video. In PALS you might play around with a chicken bone but not to any depth to where you should be doing this on a child without further training by your unit. On the first page of the text it says the course does not certify you for anything and definitely not replace the skills competencies at your hospital. Your ACLS and PALS instructors should be emphasizing this to the class. Epic fail on their part if you leave a class believing you are fully competent to do skills you had not been adequately trained for.

Transport team members spend at least a day learning alternative access methods. How do you decide to stick the tibia, humerus or sternum? Not all patients will be unconscious, dead or 20 year olds making tough guy YouTube videos. Do you know how to prep the conscious patient?

What about the EJ which is a PIV? I don't see nurses using that site very much and it is in their scope of practice.

Part of your assessment is to know if a patient might need a central line or a PICC just like I assess for an art line. People in the ICU shouldn't be without access nor wait until an IO is necessary. I don't think we have ever had to resort to that in any of our ICUs. The NPS and a few doctors have utilized them on the floors and the ED but mostly as teaching examples.

[KJoRN81, RN]

ACLS does teach IO insertion, and has for about a decade. Your facility does reserve the right, however, to enact a policy that specifies that only physicians can perform this ... even though it's an asinine policy.

Maybe it depends on the state (I live in Iowa): I just had ACLS certification & the only time IO was brought up was in mentioning access sites. We didn't learn anything about placing them.

"It never gets easier. You just get stronger."

[toomuchbaloney]

I learned how to place IO's years ago in a teaching hospital as a portion of our PICU transport protocols.

[That Guy, BSN, RN, EMT-B]

Just because it is allowed at the state level doesn't mean the hospital has to allow it to be done. In some states RTs can intubate but the hospital does not allow it. Ive placed a fair share of them in my short career and love them when you need something 30 seconds ago. Shame they removed that tool from you.