Tell me if this is the norm in your er!

Specialties Emergency

Published

Hi everyone...we had an er visit last night, and I don't work ER full time anymore (moved on to another specialty) although I do work agency in the ER now and then. I am a trav nurse, currently in NM, and havent worked in an ER here yet.

So here goes! My son had to have a nice lac on a toe sutured....the Er we went to did things a bit differently than I am used to, and I am wondering if it is the norm? Have worked many states in the Er and many different types of ERs...

1. only irrigate wound with saline, no betadine, no chlorhex, no doc cleaning it with anything before suturing. I was told that this is normal practice now, as they feel that all the cleaning agents are just too caustic to the tissues.

2. an RN came in to inject the lido (before they decided to do a digital block), and she also said that that was the norm there.

3. as I was further talking shop with the ER tech, she told me that normally the techs suture nearly everyone up...that it was just since none of them had experience with the type/loc of the lac on my son's foot that we got the doc. She said that they get some special training, then are allowed to suture.

I am all for streamlining throughput in the ER, but I was taken by surprise. Are these items the norm in your ERs? Curious! I just kept saying, I have never heard of such a thing before...

?

thanks!

PAERRN20

660 Posts

Specializes in ER.

No way any ER tech would be suture me up! We still clean with saline, betadine, hipacleanse, etc. Physician does the lido. I would be ok with the RN doing the lido I guess, but NEVER would an unlicensed tech be suturing me! I'm sure the risk of infection sky rockets. Also, isn't that practicing medicine without a license? Maybe I'm wrong, but I personally do not know any RN's that suture, let alone techs. Unbelievable!

rjflyn, ASN, RN

1,240 Posts

Specializes in Emergency.

In my 21 ED yrs NO. If it were an ARNP yes. Techs might put on dressings or do splinting after the fact. There would be no way in hades any tech I know or have known that i would allow to suture me or my family members. In fact there are some doctors I might refuse to do the same. Someone was full O crap.

I thought it sounded wild too, glad to see I wasn't totally off base since I'm not full time ER anymore. I also sat there and thought, uh, no I wouldn't let the tech suture my kid. But I think I have heard of hosp making policies for RNs and medics to have expanded roles to do a lot of stuff like that, I remember a post here a few years ago about that, but have never seen it in practice. They were very matter of fact about it, stated that this particular hosp system was the only one in the area that was doing this, giving extra classes and training etc, not the local level 1 or university center either. I think they are trying to speed things in the ER without hiring an extra doc or mid-level, I think they said they had 15 rooms and one doc only.

Thanks for chiming in!

ERNurse752, RN

1,323 Posts

When I left ER, they were going to just NS irrigation for lacs - for the tissue damage reason you said, and also because the mechanical act/pressure wash effect of a good irrigation was found to be what really cleaned the wound, not the actual agent used for the irrigation.

I worked in various ERs, and in the Level I the nurses did the lido.

Never heard of ER techs suturing.

TiggerBelly

177 Posts

Specializes in ALF, Medical, ER.

There is absolutely no way a tech should be suturing anyone regardless of how much training they have. A doctor or a PA should be the only one suturing anything. That goes beyond the tech's scope of practice.

GilaRRT

1,905 Posts

There is absolutely no way a tech should be suturing anyone regardless of how much training they have. A doctor or a PA should be the only one suturing anything. That goes beyond the tech's scope of practice.

How is that. Assuming the tech is educated, the physician delegates the task, and the facility has a specific policy and procedure in place that deals with the practical and legal issues, I see no problem.

GilaRRT

1,905 Posts

Hi everyone...we had an er visit last night, and I don't work ER full time anymore (moved on to another specialty) although I do work agency in the ER now and then. I am a trav nurse, currently in NM, and havent worked in an ER here yet.

So here goes! My son had to have a nice lac on a toe sutured....the Er we went to did things a bit differently than I am used to, and I am wondering if it is the norm? Have worked many states in the Er and many different types of ERs...

1. only irrigate wound with saline, no betadine, no chlorhex, no doc cleaning it with anything before suturing. I was told that this is normal practice now, as they feel that all the cleaning agents are just too caustic to the tissues.

2. an RN came in to inject the lido (before they decided to do a digital block), and she also said that that was the norm there.

3. as I was further talking shop with the ER tech, she told me that normally the techs suture nearly everyone up...that it was just since none of them had experience with the type/loc of the lac on my son's foot that we got the doc. She said that they get some special training, then are allowed to suture.

I am all for streamlining throughput in the ER, but I was taken by surprise. Are these items the norm in your ERs? Curious! I just kept saying, I have never heard of such a thing before...

?

thanks!

If the laceration repair occurred in New Mexico at a hospital where tech's are allowed to do wound closure (specific wounds/criteria), I suspect you are in the Albuquerque area?

Vito Andolini

1,451 Posts

Maybe the laws vary by state.

Medics suture in combat. Some places, RN's sew episiotomies, don't they?

Unlicensed personnel give meds, I guess they can suture, too, with proper training. Not saying I would like it.

r0b0tafflicti0n

196 Posts

Maybe the laws vary by state.

Medics suture in combat. Some places, RN's sew episiotomies, don't they?

Unlicensed personnel give meds, I guess they can suture, too, with proper training. Not saying I would like it.

Paramedics are allowed to suture in the field, and in many ERs the techs are Paramedics (Children's in Chicago only hires EMT-Ps as techs, for example), so I don't see why they couldn't suture there.

morte, LPN, LVN

7,015 Posts

perhaps the bottom line is....is the patient getting what they are paying for? are they entitled to a mid level or higher, and can they refuse anyone else? providing that they are informed.....have they really consented to the treatment if they havent been informed

r0b0tafflicti0n

196 Posts

Perhaps? I'd be pretty comfortable with simple suturing from a paramedic, myself. They're a highly skilled group; they're even allowed to intubate. Suturing isn't really rocket science, imo.

In fact, why can't RNs do simple suturing?

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