Respiratory Therapists Inserting PICC Lines

[Asystole RN]

Here in Arizona several of the hospitals have started an experiment, they are actively replacing PICC nurses with RTs and calling them "Vascular Access Specialists." These RTs will place PICC lines, midlines, and US guided PIVs. My local INS chapter has not issued an official statement about this and my local AVA chapter is fully supporting this with about half of the members being RTs.

Any thoughts on this? Has anyone seen this in any other State?

[Asystole RN]

Putting in PICC lines is NOT an nursing exclusive procedure.i feel that if it helps the patient and you were properly trained (not just a semester or 4 hr class ) then we should all do what's best for the patient. If you touched those knob thingys and someone dies then yes you are responsible. I don't mind as long as you don't mind me pushing those same meds and procedures you perform. The thing is I've never come across a nurse who actually knows what those little knobs and flashing lines on the vent really means.not saying they can't but I never question what you can do just like I hope you don't question what I can do and know.i welcome any dialog. .

It is not a nursing exclusive procedure but have you ever used a PICC? I don't mean just flushing them or maybe Activasing one, but have you ever had to use one to give medications? If you do not have a background in infusion therapy then you are do not have the prerequisite training or experience to be involved in vascular access IMHO. This isn't just for RTs, this is the broad requirement that all of my employers utilize when determining if a RN is to be trained in vascular access, and I agree with it.

What State are you practicing in out of curiosity? Do you currently place PICCs yourself?

[tmw73]

I practice in florida.and it's funny that you ask that because we were having that very discussion with our department heads last week.thats how I came upon this board.we are in the beginning fa phase of respiratory taking over this practice.like I said before this is not a ******* contest but when I read all the post on this subject of course I took offense to this.at my hospital and others I worked at there are a few nurses who have this fixation on thinking there doctors.but for the most part respiratory therapist does alot and we're pushing formore which I dondon't think is bad . respiratory and nursing work very well together where I'm from.we don't have all this in fighting with each other. We respect each other and help each other like it suppose to be.they don't mind the whole Picc line issue because they know we're competent in doing it.i don't know how everywhere else is but here the view is that of a team.not who does the most.they know I f they have a problem they can count on us.if it's a respiratory issue once we get there they leave that to us.the laws here are very vague as to what can be performed so we take everything to its limits.i know alot of people read all the negatives about Respiratory but we are getting legislation to have more access to patient care.were also trying to get reimbursement for those things we do.once the hospitals can get reimbursement for more things we do we become more of an asset.this will benefit respiratory and nursing. I think if alot of these nurses on this board actually seen the curriculum for respiratory you'll see its not that much different from nursing. My wife, mother in law and grandmother are nurses.i studied with my wife for her nursing degree.i know what is taught in nursing because I've seen the curriculum. I don't diminish nothing you do but to be told you can do all I can do is simply not true.there are ALOT in nursing that doesn't even touch the depths of the respiratory system that we've gone over or vent management. Those are just some things.also here in Florida when we do our broncos there's a respiratory therapist that pushes the narcotics and sedatives. We also give morphine news with patients with end stage lung cancer.the way you learned about drugs is no different that what we've learned.im a registered respiratory therapist and believe me there's a difference between the licenses of respiratory. If your state allowed respiratory to do more it would be easier on your back as far as work load.here we have respiratory in the cath lab, OR, all the ICUs, ER labor and delivery. We're all over the hospital and still hiring.most states are increasing the scope of respiratory especially in the Carolinas. With these changes to health care everyone will be expected to expand their role.we are no different.do me a favor and check out the curriculum for respiratory and tell me what you think..we learned alot more than what was required but like I said before all that's changing. I do respect the fact that we are having a discussion without sticking our chest out.i was just shocked at the amount of no respect on this board . especially with the guy who told me that they just call the therapist when he's needed.i guess I'm suppose to believe in his ICU that there no respiratory therapist. JACHO would not allow that.i know that for a fact.thanks for the conversation though.its always good to get other people's perspective. .

[tmw73]

Please excuse my typing i have big hands and a small phone.plus this auto correct sucks.

[tmw73]

And also for flying Scott you cannot do everything in respiratory scope of practice. You may do some just like my license in compass yours.i see there will be alot of sad people if this legislation passes.when did you go over ventilators in school and please don't tell me you did.my wife has her BS in nursing and in no way did they go over vents the way we did.so if your ttelling me you have more knowledge of the ventilator than i do i know that you must have some kind of complex again respiratory.

[tmw73]

And to answer your question yes i have accessed a PICC line before.even helped with the procedure of placing one on a number of occasions. .

[BuckyBadgerRN, ASN, RN]

Ah, a phone. That explains a lot =) One word: paragraphs. It IS really hard to read your well thought out responses...

Please excuse my typing i have big hands and a small phone.plus this auto correct sucks.

[FlyingScot, RN]

And also for flying Scott you cannot do everything in respiratory scope of practice. You may do some just like my license in compass yours.i see there will be alot of sad people if this legislation passes.when did you go over ventilators in school and please don't tell me you did.my wife has her BS in nursing and in no way did they go over vents the way we did.so if your ttelling me you have more knowledge of the ventilator than i do i know that you must have some kind of complex again respiratory.

I have no issue with Respiratory Therapists except those who think they can/should do everything a nurse does while maintaining that a nurse should not intrude on respiratory's territory. And please do not put words in my mouth. I never said I have more knowledge than you do but I have more respiratory knowledge than you think as I spent many years managing vents ont the sickest, most vulnerable patients you can imagine. So, yes I know what the "knob thingys" do and what the "flashing lines" mean. You speak out of both sides of your mouth. You say you respect nurses but then say they know nothing about respiratory therapy and derisively describe the equipment as "knob thingys" as if we are idiots while all the time extolling how you can do our jobs as well or better. Fortunately all of the RTs I have had the pleasure of working with were true collaborators who were open to RN input on respiratory plan of care including ventilator changes because they valued our knowledge as well we valued theirs.

[tmw73]

Thank you for your understanding.

[tmw73]

Well you misunderstood what i was saying. I never said i was better. I said that on more than one occasion. I said both schooling crosses both.i don't think i know nursing better than you just like i don't think you know respiratory better than I.i just read some of these responses and put my 2 cents in.im not one of those turning knobs and breathing treatment therapist. I don't know how things are where you are but they don't work like that here and would never work like that.when i hear one say. (it's my patient) well no that's not true.you are responsible for what you do and I'm responsible for what i do.ive been doing respiratory for 20 years now.ive work in about all aspects of the medical field.ive done transport, pediatric trauma you name it I've done it.ive taken care of very sick people as well.what i was saying is that when you have inflated attitudes it hurts the patient. It's a shared responsibility. I've said that on more than one occasion. I also said that it's due to legislation that respiratory isn't able to do everything we learned not because of knowledge. I also said that will change in the future. I in no way demean the nursing profession but to think that we are a sub title entity then you must not know all of what we do.i just said check out the curriculum and you'll see.i think you might be surprised. I think there are aspects of both jobs that cross but to think you have a better grasp than I.i believe is not true. Tell me this is there any difference in how you calculate drugs, we were taught that.how to give blood transfusions? We were taught that as well.regulating insulin drips? We were taught that as well but we're not able to use this knowledge. Why because of legislation not because we were not taught.alot is going to change and if the bill we have before congress now passes alot of this will be a thing of the pass.there were studies done by doctors in California to Maine about the impact of including a respiratory therapist more included in patient care with every study having better outcomes as a multi disciplined group approach. I'm just letting you know what's coming and going to happen and all this will be a thing of the pass.so i will say this again......i in no way demean your profession but i see respiratory equally as important and alot of hospital administration's are as well.thats why things are going to change . especially when readmission penalties start kicking in and believe me they will.i think you should attack in all ways possible as a multiple disciplined group not with a few having superiority complexs.im more than willing to teach nurses techs and anyone that has a question about Respiratory. Alot of the nurses i work with would be more than happy to tell you.last time I check neither of us went to med school so we both are limited in what we know but we can make a very good duo when you have a good nurse and good respiratory therapist. .Do you not agree with that?

[PMFB-RN, RN]

.when did you go over ventilators in school and please don't tell me you did.my wife has her BS in nursing and in no way did they go over vents the way we did.

But your wife went to nursing school in Florida, correct? SO in nursing school they also never went over intra aortic balloon pumps, dialysis machines, LVADS, or ECHMO, yet all of those are regularly used by nurses every day, same with vents. Anyone with a good understanding of respiratory A&P and patho can learn to operate a vent, just like any of the other equipment we use.

[PMFB-RN, RN]

I practice in florida.

Well this explains pretty much everything, including your condescending treatment of nurses.

[FlyingScot, RN]

Alot of the nurses i work with would be more than happy to tell you.last time I check neither of us went to med school so we both are limited in what we know but we can make a very good duo when you have a good nurse and good respiratory therapist. .Do you not agree with that?

Of course I agree with that I'm not an ogre. But until you agree that nurses should be cross-trained to manage ventilators and such I'm going to stand firm on respiratory should stick to what they do best. Otherwise we'll end up with jacks of all trades and masters of none.