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...
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.
I've never heard of RNs suturing episiotomies! CNMs do, but then they also deliver the baby!
Just because someone has been "trained" in something doesn't make it within their scope of practice. I'm sure that some RN's could be taught the procedure for initiating and maintaining general anesthesia, but that doesn't mean that it's within their scope, and they certainly shouldn't be doing it! (Nurse Anesthetists aside.)
Medics do not typically suture in combat. The priorities of care in a combat situation revolve around achieving tactical superiority, extricating the patient from the environment, and hemorrhage control if possible. Even further along the continuum in the Medical Evacuation care phase, suturing is not a priority.
I found this thread trying to research USA hospital ERs using RNs to suture. I have been charged with this research for my ER. If anyone knows of any EDs employing this practice, please let me know.
Goodness, I would just be glad if a doctor or ped. would be willing to put in two or three stitches in their office. But no way, off to the ER for something minor that they could easily do in the office most times. Office docs don't seem to want to deal with much of anything anymore--it's sad really.
the irrigating of your son's laceration sounded "normal", did they offer a tetorifice or at least screen your kid for this? Techs suturing? absolutley not normal unless they are specially certified like an OR or cath lab tech!! The
doctor does the documentation of the wound and the medical doctor or PA should have assessed the wound before it gets closed by sutures. I am employed by an inner city Er in Las Vegas, NV as the Supervisor
thanks again everyone-every er I have worked in in my time, I have seen no one suture other than MD, PA, or NP-that is why I was so blown away. Same thing with only cleaning with saline, can't see why we can't even do some kind of soap if betadine is now felt to be too caustic to the tissues.
they did vaguely ask me if my son's shots were up to date, which was yes, and I think tetorifice is in there somewhere!
Sarey-the nurse and tech stated that you don't even see a doc if u have a lac type that they have experience suturing-this was all, per them, to increase throughput through the ER...there were many statements of how busy the doc was and he didn't have time to do everything. (community er, 14? beds, one doc, no midlevel).
yes I wonder how the charging of the suturing would go...
Most comments on here are absolutely against Nurses giving lido and techs giving sutures. Why? Lido isnt dangerous and pretty hard to screw up the administration of. Techs do all the hands on/clinical stuff and would most likely have the most experience at suturing. I would allow a tech to start an iv before a Nurse or Doctor because they do it all the time. I personally think if someone has the training and practice the skill often, they would be the best candidate to do a procedure versus someone who doesn't practice the skill much. Just saying.
In VA we can't inject the lido, but my best friend came from california and it was within the scope of practice for an RN to numb the site.
The Saline, Absolutely, with pressure (used in the syringe) it is sufficient to irrigate the wound without cause additional trauma, your not dealing with potial caustic agents(betadine) and Goodness if they have an iodine/shellfish allergy your not risking that.
We do occasionally irrigate with surcleanse but usually that is followed with saline.
mommy2boysaz
288 Posts
I've never heard of RNs suturing episiotomies! CNMs do, but then they also deliver the baby!
Just because someone has been "trained" in something doesn't make it within their scope of practice. I'm sure that some RN's could be taught the procedure for initiating and maintaining general anesthesia, but that doesn't mean that it's within their scope, and they certainly shouldn't be doing it! (Nurse Anesthetists aside.)
Just my opinion.