Vascular Access RN

tmv73, I have not once attacked your competence at what you do, or your facility; though it is tempting, I still will not. My facility is not small, is financially stable, and receives third party recognition on a regular basis for excellent patient outcomes. As to me, I am modestly known in my field and have stellar patient outcomes. Oh...and yes, I am at home, answering on my computer. When I am at work, I am taking care of patients.

@ tmv73: Your response would indicate that you did not read my post at all. I know for an absolute fact that the RTs I work with would run circles around me when it comes to excellent respiratory care. It is their specialty, they chose it, they focus on it. I am grateful for them. I also know that I would run circles around RTs when it comes to knowledge of infusion therapy and vascular access devices. It is my specialty. And, the RTs at my facility have a great working relationship with the nurses and vice versa. Healthcare is a shared responsibility and an area where tasks overlap. Delegation is inevitable and necessary. However, if tasks become so diluted as to lose the physiology and rationale behind the options available, we WILL see poor patient outcomes. Combine that with the bedside cuts that administration constantly makes (this is all bedside clinicians: RT, RN, CNA), and we have a recipe for disaster. Look at the ranking of our outcomes and longevity in the U.S. compared to other countries as it is now. And, BTW, outcome studies recently showed that RNs with experience at the bedside directly coorelate to lower length of stays and better patient outcomes. tmv73, I am not saying that RTs are not valuable, they are, in fact, invaluable. But IV medication is outside their scope of practice, therefore, they have no direct experience with the ramifications of that IV catheter that they are placing. A slippery slope.

I've been reading over these "new" comments. Spelling, paragraphs, and grammar do reflect legibilty, which in and of itself is interesting to me. I did learn the fundamentals of ventilator settings and controls in nursing school. However, my first several years as a nurse were outside the critical care arena. When I eventually did transfer to intensive care, I learned how to care for a vented patient from ICU nurses and RTs. Our RTs are excellent respiratory support and helped me save my patients many times. I always look to our RTs for expert respiratory care advice. Hospitals that do not have them are missing out on an excellent resource. That being said, infusion therapy is outside of their scope of practice. RTs do not administer the medications that nurses do intravenously. Not only are nurses required to understand the medications they give and the effect on the body, but they have real time experience with the IV route. The vascular access NURSE uses this experience, plus in depth knowledge of dilutional pH, venous reaction/irritation, and osmoality to not only "place a line" but place the correct one for the patient at the time. Do not try to say the this choice is "up to the doctor." While the physician does prescribe, the nurse treats. The doctors do not have the same focus that a vascular access nurse does. DAILY, when at work, I call a physician who has asked for my services to tweak the device he or she had ordered based on what is best for the patient at the time. Sometimes, they grumble, but they respect me for it. Yes, we are all part of the healthcare team. What has not been balatantly stated by these posts is doing WHAT IS BEST FOR THE PATIENT. IF we think in this manner, the professional with an intravenous infusion scope of practice and experience is the one I want putting vascular infusion devices in my loved ones or me. AND, I want a respiratory therapist managing their airway and respiratory care.

Then I would speak to the hospital administratores. Outpatients are their bread and butter when it comes to lines, though I would partially agree with IVRUS -- although many medications (like Vanco) should run through central lines (PICCs). I usually suture the line in place in the case of a demented patient who requires a PICC. And, I usually place short IV catheters in patients that pull lines who do not require central access!

It's not the nurses who are unwilling to step up -- it's the administrators who don't want to pay on call time or for 24 hour service. Unfortunately, it is the nurses who unfairly take the fall.

Can not say more at this time, Asystole RN...I can not identify with any institution or corporation, as doing so may have an ultimate negative affect on patients.

"Considering that RTs are paid less AND can bill for their services we will see them expand their roles into other areas of nursing. Vascular access is simply the vanguard of the movement, the method to test the waters." Asystole RN: This is not correct regarding Venous Access Device insertion. Some were billing for this, but had to stop.

Thank you, Woosha RN, for being brave enough to speak out.

PMFB-RN: This is us too. Except that our Admin won't give us enough staff for nights.

The fact that Lynn and others so readily make it the vascular access nurses fault that all hours aren't covered is generalizing, stereotypical, horse pucky. As I have stated much more than once, many of us have begged to have night coverage, even work night coverage, only to be told "no" by our administrations.

Not where I work, thank goodness for our patients.

This is why I invite you to do the research for your state or any other about which you are curious. I know you cannot know anything about me personally from my posts, other than my spelling and syntax. In response to Nietzche's quote--I am hiding among the monsters.

This IS practice at the many facilities in AZ where RTs place and maintain lines. The RTs first aspirate every device when they check patency (during routine maintenance or troubleshooting after insertion). They have to, as intravenous medication delivery is outside their scope of practice. It is believed (by those in charge) that this gets them around scope of practice violations.

I continue to be unclear, I suppose. ANy TECHNICIAN with ethics and a brain can learn to do a procedure and over repetition become successful at the procedure itself. Vascular access is more than that -- this is something no administrators recognize and only some nurses do. The RIGHT device at the RIGHT time is imperative to minimize lifetime scarring and damage. EVEN FOR SUCCESSFUL SHORT TERM IV PLACEMENT. This requires knowledge of infusate properties, catheter risk benefit ratios related to those properties, a host of underlying conditions, illnesses, co-morbidities, etc. THAT is why the RN foundational training is the appropriate one. The comment about LPNs also disturbs me. I will concede that other disciplines may learn the task, and with an exorbitant amount of additional training, eventually be able to see the whole picture to drive the patient's insertion and care of the right device at the right time. I also believe that with the guidance and oversight of registered nursing or an L.I.P. (again, PA, NP, MD, DO, etc.) an RT can be taught to be an insertion technician. However, each case would need to be reviewed by a Vascular Access Specialist of the above mentioned appropriate disciplines for the right device. "MunoRN" you keep assuming, which so many others do as well, that the non-specialized RN can make these determinations; or the non-specialized L.I.P. can do so. Vascular Access needs to be its own discipline. And, registered nursing is the only non "advanced" degree with adequate foundational education on overall physiological conditions, medication properties and delivery modalities, etc., prepared to be this specialized. Across the nation, healthcare is by in large doing our patients injustice with anything less.

I can say no more than I have; I do not wish to reveal details out of concern for institutional privacy and reprisal. What I am warning is that institutions and individuals must check with the professional boards BEFORE "diving in." I invite anyone interested to look at the curricula in their respective states, and to READ their professional practice acts and rules and regulations. This step is imperative before permitting any new skill. I HAVE ABSOLUTLELY NOTHING AGAINST RESPIRAORY THERAPY AS A PROFESSION. As I stated last time, within their scope, they save lives and are an invaluable part of the healthcare team. And, no, RTs may not charge for this procedure, any more than nursing can.