arterial line insertion by OR/PACU nurses

sharann, BSN, RN · Mar 1, 2005

NOPE.

NO WAY.

UH UH.

Unless you are a CRNA or MD. Unless there is some rule I have never heard of.

Do you need to risk your licences for the surgeons and CONVENIENCE? They will bill for the procedure you perform by the way.

shodobe · Mar 1, 2005

Way beyond scope of practice. I agree with sharann, you get the blame and the MDs get to bill. If there is a rule I don't know about I would like to see it, we have Resp Techs and ER nurses who draw ABGs but I am not sure where "starting" an A-line falls.Mike

stevierae · Mar 1, 2005

NOPE.
NO WAY.
UH UH.
Unless you are a CRNA or MD. Unless there is some rule I have never heard of.
Do you need to risk your licences for the surgeons and CONVENIENCE? They will bill for the procedure you perform by the way.

I think that most RNs who have worked at one time worked in ICU--and that includes many, if not most, PACU nurses-- are accustomed to doing arterial sticks to obtain blood gases---hence, no reason why those RNs should not do insert art lines.

In most hospitals, RT techs can insert art lines.

Now, most OR nurses haven't been trained, unless they worked as RT techs or in ICU. That's why anesthesia does it--and, in teaching hospitals, there are CRNA and anesthesiologist residents falling all over themselves to start the art line (or whatever big line they want to insert.)

But, heck, if someone is trained and qualified, why not? More power to them. I like to start my own IVs whenever I can, even though we have anesthesia to do so---I could care less about billing. I have my own agenda, and that is keeping up my OWN IV access skills. If anesthesia lets me start his IV, he's doing me a favor--he isn't taking advantage of me. (I am not trained to do arterial sticks and wouldn't volunteer.)

cwazycwissyRN, RN · Mar 3, 2005

i think that most rns who have worked at one time worked in icu--and that includes many, if not most, pacu nurses-- are accustomed to doing arterial sticks to obtain blood gases---hence, no reason why those rns should not do insert art lines.
in most hospitals, rt techs can insert art lines.
now, most or nurses haven't been trained, unless they worked as rt techs or in icu. that's why anesthesia does it--and, in teaching hospitals, there are crna and anesthesiologist residents falling all over themselves to start the art line (or whatever big line they want to insert.)
not really understanding what you are saying here. i do not know any icu or pacu rns that start artlines.........are you just saying we are capable of doing it?

stevierae · Mar 3, 2005

i think that most rns who have worked at one time worked in icu--and that includes many, if not most, pacu nurses-- are accustomed to doing arterial sticks to obtain blood gases---hence, no reason why those rns should not do insert art lines.
in most hospitals, rt techs can insert art lines.
now, most or nurses haven't been trained, unless they worked as rt techs or in icu. that's why anesthesia does it--and, in teaching hospitals, there are crna and anesthesiologist residents falling all over themselves to start the art line (or whatever big line they want to insert.)
not really understanding what you are saying here. i do not know any icu or pacu rns that start artlines.........are you just saying we are capable of doing it?
yes, i believe so---if as an icu nurse you are capable of doing an arterial stick (to obtain blood gases) why couldn't you take that one step further and thread a line into that artery?
think about it. i have heard nurses say that they can't draw labs because they are not phlebotomists and have never been trained in venipuncture---but what the heck do they think peripheral iv access is, if not venipuncture?! if you can start an iv, you have been trained in venipuncture. same goes for art line insertion--if you can do an arterial stick, why wouldn't you be able to start an art line?
but, you're right--why should you, when there are highly paid anesthesia providers sitting around? i feel exactly the same way about doing conscious sedation--i won't do their job and take on the additional responsibility for what i get paid.

jwk · Mar 3, 2005

Same goes for art line insertion--if you can do an arterial stick, why wouldn't you be able to start an art line?

There's a good bit more morbidity associated with arterial catheters than IV catheters. It's a different technique.

Whether one is able to (or thinks they are) or not is not the question. The question is should they be, or is it within the acceptable or legal scope of practice.

Marie_LPN, RN, LPN, RN · Mar 3, 2005

Anesthesia starts the art line.

cleothekat · Mar 28, 2005

Hi,

I work in a non teaching hospital in the Med/surg ICU. We can place art lines if you get certified through the hospitals class. It really comes in handy to have one or 2 nurses who can place your line especially in the middle of the night when there are NO physicians available or willing to come in to place it. I think it is a great added task to your resume and skills list.

mcmike55 · Mar 28, 2005

In our small rural, non teaching hospital, only the docs start the art lines.

I'm not sure I've ever heard a nurse say they'd like to try.

Though, some would probably do a better job than some of the doc!! :chuckle

RT does art line sticks, when the pt does not have an art line.

RT or the RN will draw ABG'S when a line is already in place.

I suppose there is no reason that an RN, properly trained could not start a line. Let's face it, we do stuff now, that nurses 10, 20 years ago wouldn't have thought of.

We start all the IV's for anes.docs in the OR holding area, they come out and do the art lines.

Not sure what the Ohio BON would say, but right now, I'd say it's out of our scope of practice.

But, hey, never say never :rolleyes:

Mike

stevierae · Apr 1, 2005

There's a good bit more morbidity associated with arterial catheters than IV catheters. It's a different technique.
Whether one is able to (or thinks they are) or not is not the question. The question is should they be, or is it within the acceptable or legal scope of practice.

jwk--please re-read my post. I am well aware that arterial puncture is a different technique than venipuncture.

However, again, if a critical care has been trained (and is skilled, and if one's state nurse practice act as well as hospital policy allows it--and many do--) why shouldn't that RN, who frequently does arterial sticks for blood gases anyway, simply advocate and get an order to go ahead and insert an art line---thus saving that patient MULTIPLE arterial sticks, which are indeed invasive, and put that patient at excess risk for arterial hemorrhage, hematoma, infection, and possibly RSD (or complex pain syndrome I guess we are calling it now) as well as other potential problems?

Respiratory therapists do arterial sticks and insert art lines, for heaven's sakes. I think critical care RNs can take the same classes, if they want to, and, again, if it's allowed by their state nurse practice act and hospital policy.

stevierae · Apr 1, 2005

Let's face it, we do stuff now, that nurses 10, 20 years ago wouldn't have thought of.
Mike

Exactly. Remember when PICCs first came out---for a while there, only docs were inserting them. Now, the surgical residents who used to be so eager to do them consider it scut work, and RNs routinely do them--even in home infusion. Of course, there are classes that one can take and a learning curve associated with inserting a PICC skillfully, but I don't believe there is any national standard requiring one to be "PICC certified," unless INS has recently instituted one. Same thing with doing EJs for peripheral access---as long as you use proper technique and follow the proper precautions, and have been trained and know your anatomy and physiology, AND your state nurse practice act and institution allow it, there is nothing particularly mystical or complicated about EJ access for a peripheral line.

In fact, I know a plastic surgeon who routinely has his office cosmetic surgery nurses do EJ access for his sedation technique utilizing Ketamine & Valium. By using the EJ, the Valium doesn't burn. (Why he doesn't just use Fentanyl and Versed in a peripheral IV in the arm is beyond me, but I digresss...maybe he's just been using this technique for many years, and is reluctant to mess with what's been a tried and true technique for him.) Of course, I am certain he has a CRNA or anesthesiologist for more complex procedures and/or ASA 2 or above patients, when the Katamine/Valium technique is not an option.

Lest you think he is doing something shady or wrong, he is also an inspector with AAAASF, and frequently shuts ambulatory surgery facilities down for unsafe practices.

I remember, too, in the late '70s when RNs were not even allowed to inject NS (we used to use iced NS, back in the day) into a Swan to get a cardiac output--that was a doc's job in some places; preferably a pulmonologist or anesthesiologist. Same with wedging the Swan. Now, RNs do it without a second thought, and have for--what--over 20 years now?