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.

The comments regarding the nursing board response are correct; however, that is AZ. I am not in that state, and I am the ONLY person from my facility who contacted the RT board in my state when rumors about a blanket conversion arose. The RT board would not back the position of RT placement of venous lines. And, our team HAD formally asked for a night shift year after year. And, our team has had outcomes that would make any facility jealous for at least 7 years (that is how far back the data collection goes.) No, RTs may not charge for the procedure, although this may have been a theory in the past, upon further investigation they may not. And, though they may "flush a device" (NS for the purpose of patency is not considered medication by the FDA, they may not administer any IV medication. So, if they plan to maintain patency, they aspirate first, always. If not, they are reaching outside their scope of practice. The RT programs were complete take overs at many facilities. The RNs were showed the door. To MunoRN, do your homework. I have. There is a big difference between "on the job training" and foundational theory and practice. Please don't throw outcomes at me either. Publishing is a very political deal. And valid outcomes should be collected and interpreted by both internal and outside review. That is, end results reviewed and verified both by the department involved and another (quality, infection control, etc.) Also, outlying high risk or poor outcome incidences should be mentioned.

Yes, your are missing my point. 1. I have investigated the basic education curriculum for RTs education (in my state). THERE IS nothing close to venous access (even basic), the effects of venous access on the vessel, the effects of infusion therapy on the vessel, and on and on in any course description. 2. This is QUITE the opposite for RN education, with training in all these areas. Since the collegiate foundation is the basis for scope of practice, RT preparation falls sadly short. And, I do not believe it would be very difficult to convince a jury of this, especially with just a few facts. Furthermore, it is far less of a reach, based on the above FACTS, to extend nursing specialty in PICC and even CVC placement, than to offer the same to respiratory therapists. Also, I have been placing venous access in challenging patients for well over 20 years. While you may believe that the bedside nurse makes the final determination on the line that the patient will receive based on likelihood of best outcomes, you are sadly mistaken. This would be analogous to the primary care physician having the final say on the best chemotherapy regimen rather than the oncologist. Or, if you prefer, the general medical surgical nurse deciding the safest way to administer that chemotherapy verses the oncology certified, or vascular access certified, nurse. Also, do not think I devalue the role of respiratory therapy as a specialty. Their mastery of ventilator settings, patient response, and respiratory care makes them an INVALUABLE member of the healthcare team. I am sorry I did not state this in my initial remarks. Finally, while nursing sadly lacks cohesion as a profession, it is foolish and incorrect to assume that "it's our own fault." IF you are a RN who has had to fight political and administrative battles for the sake of patient safety, then you are aware of just what we are up against. I thought long and hard before posting my previous comments. I have valid reason to believe that the current course of events is a jeopardy to patient safety, and thus have stood up in what I believe to be a calculated risk. There comes a point where the individual interested in pursuing new avenues, especially within the broad scope of healthcare, must receive additional foundational training to be prepared to take on far reaching new challenges. Respiratory therapists do not receive the foundational training necessary to adequately choose appropriate venous access for a patient. Should the individual RT decide that he or she wishes to place venous access, they should seek the collegiate foundational training first, visa via, return to school in a discipline that does have such a foundation (licensed independent practioner-that is, PA, NP, MD, DO, etc. or yes, nursing school.)

So, I will tell you why RTs should NOT be placing lines. It is not within their scope of practice. Period. For nay-sayers, here is specifically why: 1. Review their education process -- vascular access for intravenous medications is not part of the curriculum. 2. Veins are scarred with every puncture, therefore, the least invasive access adequate to the task should be used. * Surprise! The physicians and bedside staff do not always know which catheter is up to the task. Each patient case a vascular access specialist is consulted on should be reviewed, based on patient history, co-morbidities, current intravenous therapy qualities such as pH and osmoality, and length of said therapy (to hit the big ones). NO where is this review possible within the scope of an RT's education and training. However, it is EXACTLY the practice of the vascular access RN. What do I believe will happen to WA and AZ et al states where RTs are performing these tasks? All it will take is one mistake leading to a bad patient outcome. Too much or too little catheter, an insertion error, an xray interpretation error on the part of the procedural RT. Any lawyer and legal nurse practitioner worth their salt will not only go after the RT and hospital, but also the State Board of Respiratory Therapist who allowed this practice to start! The problem is, that a patient, if not patients, will pay the price. That being said, specialized vascular access nurses may also error. However, the difference is they are working within their scope of practice (review nursing education and expectations). Therefore, the nurse's educational background and infusion therapy experience makes these mistakes much less likely, especially if she or he is specialized. Also, administrators need to WAKE UP to the fact that the least expensive care is always going to be that care which returns the patient to a functional state of wellness in the quickest manner possible (i.e. the BEST care for their targeted need(s). Can I get an AMEN?