Respiratory Therapists Inserting PICC Lines

First of all, A patient who is deliberately pulling out a PICC or even a Midline, is NOT a candidate for repeated lines such as these. I will place a short term, less than 3 inch IV catheter, but that is all they get from me. Both INS and our institutional P&P have information that will back up this stance. In LTC, restraints are a big no-no and therefore, sometimes the only way to get that medication in is to restart them (FREQUENTLY) I might add.

Except when I did get to speak to one of the two RN's who do place PICC's at the local hospital, she made it very clear that she sets her own schedule as far as placing PICC's. And her partner likes to take Friday afternoon's off to go and care for her ill Mother in the next state, so "we never place after 11am on Fridays!" It's pretty small town, I'm telling you, this RN does indeed set her schedule!

And you think that the staff nurses who place those lines have any say whatsoever in FTEs and scheduling?

My hospital staffs banker hours too, to be fair the scheduling department does too, so it can sometimes be difficult to fit a patient in within the schedule. The vascular access team has tried again and again to increase our availability and the FTEs to cover those hours but the admins refuse. This isn't something that comes from the director level, this is CNO/CFO level stuff.

Do you as a staff nurse have any appreciable influence of FTEs at your facility?

Except when I did get to speak to one of the two RN's who do place PICC's at the local hospital, she made it very clear that she sets her own schedule as far as placing PICC's. And her partner likes to take Friday afternoon's off to go and care for her ill Mother in the next state, so "we never place after 11am on Fridays!" It's pretty small town, I'm telling you, this RN does indeed set her schedule!

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!

I've been reading some of these post about RRTS in certain PICC lines like it's something so impossible. I mean some of them sound down right degradable. Inserting picc lines can be done by respiratory therapist and I don't see why they cant.whats so hard about it that nurses can do it but a respiratory therapist cant.there are alot of things in the medical field that are the way they are because nursing is a very old profession and respiratory is fairly new.i don't know what you think they taught us in school but picc line insertion is something that is taught among other things that most hospitals are only now seeing. We are a very dynamic profession and can do alot more than what we are allowed to do in the past.only now do some administrators see our potential. I love the nurses that I work with.my wife, mother in law and grandmother are nurses.ive seen the curriculum for nursing and there's nothing more strenuous and bout nursing than respiratory therapy. I don't know if you've noticed but respiratory therapy is in an evolutionary change and most people want that.we are becoming a very ingrained part of patient care and it seems alot of nurses don't like that.to me that's sad if you feel that way.those who said nurses make more than respiratory , we'll for a profession that's as old as nursing you should make alot more but that will change as well.i know alot of nurses that don't make as much as I do.but then again I make my worth known.what ever administration will allow us to do we will do. There's legislation to increase that as we speak.As a nurse you should welcome that.Dont forget I have a license just like you do.of I do something wrong to a patient they'll come after my license not yours so it's a shared responsibility. And just in case you don't know those little knobs we turn make all the difference in the world as far as lung compliance. It's not that we are all territorial but I have to answer to everything done to that vent that's why most like to make those changes themselves. The same way you feel about your profession so does everyone else. As far as the military not recognizing RRTS that's changing as well.In the near future Respiratory Therapy will have an increase role in all aspects of patient care.This is not to demean anyone's profession but to think respiratory therapist can't do alot of what nursing does is just plain silly..remember it's only because of legislation not knowledge and that will soon change as well.you should support this change cause it'll help us all and help with better delivery of patient care.before you start telling me that you can do all aspects of respiratory therapist let me remind you I've seen the curriculum and there's nothing hard about it so doing alot of nursing duties we can do that as well.we all just CHOSE different professions.

Sorry my language is so choppy.i wrote that in a hurry.i was on my break and had to run to a code i guess that some think we are unimportant for..

I'm not dragging nursing down.i have no wish to but to always believe that we are here to assist you is completely wrong. We are not physical therapist, or aides.we have licenses like you do.im responsible for all that i do.ive never seen a nurse lose their license due to an poor respiratory therapist. Respiratory performing more duties is a good thing for both professions.as far as deregulation of the license it won't happen. You talk about law suits? It has been tried before with very poor outcomes. Do you know that Congress is going to vote to include Respiratory in medicare reimbursement? If they do alot more doors will open for respiratory therapy. Once we get reimbursement alot will change.with the PPS system in the 90's that took respiratory out of snf it only proved that they need respiratory therapist to help cut down on readmissions.there were studies done where doctors advised the hiring of 24hr coverage of respiratory therapist. I know alot of you hate to hear that but yes alot us going to change.alot of small hospitals will close.things will be more concentrated.more focus on specialty care which is right up respiratory ally.im not sure about the whole poor pay thing.like I told you where I'm from we make more than nurses do.i know it's different everywhere but here that's how it is.ive worked in every aspect of the medical field and there's no reason that respiratory can't do alot of what nursing does.we learned the same drugs you did.we had extensive work on hemodynamics and yes we can run codes..I've done some of them myself along with intubations..In all don't sale respiratory therapist short especially if you've never seen the curriculum for respiratory. You might be shocked at what's taught.believe me they don't teach us breathing treatment and turning knobs for 3 years.please before you bash respiratory look up the curriculum. There are alot of Congress men who are doing that right now and will be surprised that were not more utilized...like I said before, this is not a dump on nursing. I respect every last one of you but to think that we know nothing and that our knowledge is limited to breathing treatments because of hospital administration not letting us grow is a huge mistake. .thanks for letting me put my 2 cents in..

So following your line of reasoning then I guess you wouldn't mind one bit if nurses started "turning those knobs" on that ventilator thingy. Nursing is,after all, evolutionary and in certain circumstances we actually CAN do everything an RT does.

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. .

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. .

Come work in my hospital. Nurses run their own vents. We do have a single respiratory therapist in house who does vent checks and serves as an expert consultant if we call and request his assistance, but otherwise nurses run their own vents. We set them up and have them ready for the post op patient, manage and adjust vent setting, change circuts and extubate our patients as ordered, or, much more often, per protocol. Same thing for bi-pap and c-pap. Many of the emergent intubations are also preformed by specially trained RNs on the rapid response team.

Well you have to let me know where that is.ive never heard of a nurse doing all that.id be interested in what hospital that is.that would never happen here.i sure they have a respiratory therapist there for a reason.if you did all that then why even staff one? I guess they don't feel like your hospital is that competent doing it or they'd just lay your respiratory therapist off all together.right.