My hospital is considering allowing CT techs to access and deaccess implanted pressure injectable ports for contrast pressure injection. Is anyone else doing this? I have expressed my concerns about critical thinking and potential complications with the port access. I also questioned whether it was legal for CT techs to administer heparin to deaccess the port. While I have been involved in discussions on this topic in many hospitals, I have never been in a hospital that allowed it. What are you all seeing in regard to this?
Leigh Ann
Leigh Ann Bowe-Geddes, RN, CRNI, VA-BC
Vascular Access Specialist
University of Louisville Hospital
The diagnostic imaging departments I am familiar with since about 2000 have RNs who do this.
I am working on a radiology education project now and have not found anything from the ASRT stating that it is acceptable for RTs to access implanted ports. This may be a procedure that could be learned by the new group of Radiologic Assistants, which are a higher level of technologists. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Scope of practice for Radiology Technologists depends on a few different governing bodies. In some states, Radiology Technologists are licensed or registered, and use the designation RRT. They will have a scope of practice simi;ar to nursing, and usally as vague. Generally, unless it says "do not" or "can not" they can, according to the state.
If the state has no scope for RRTs, and some do not, their scope is then determined by the ASRT, their professional organization. Regarding this practice, ASRT states:
Vascular Access
Accessing existing peripheral or central vascular implanted devices or external access lines to administer contrast media, radiopharmaceuticals and medications or maintaining line patency is within the practice standards for radiologic technologists with appropriate clinical and didactic education where state statutes and/or institutional policy permit.
Adopted by the House of Delegates, Resolution 99-3.03, 1999
So, since 1999, if the State or the hospital does not say they can't, then they can, and in fact, this is common practice at many hospitals across the country. The hosptial has to have a policy in place, and it is recommended that the RRTs have compentency tests like RNs have to, especially if this is not something they do on a daily basis (High Risk Low frequency tasks)
Many hospitals have a similar policy for both RNs and RRTs regarding CVAD access and use in Radiology.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
I am a PICC RN from California who has worked in a Radiology Dept/IR for greater than 10 years. This subject came up several years ago when we converted to power injectable PICC's and CVC''s as a Radiology RN is not on duty during the late evening and night hours. At the time the Director of Radiology researched to make sure of what he already knew, that it was not within the scope of practice for a radiology tech to access, check for patency, attach the contrast tubing to the hub of the catheter or flush central lines and subsequesntly wrote a specific policy addressing this. If a patient came to either CT or MRI for an angio study with a power PICC or CVC, the RN would confirm patency by the ability to withdraw blood and confirm tip line placement in the lower 1/3 of the SVC or cavoatrial junction with the Radiologist. It was at that time the RN would confirm with the Rad tech the noted ml/sec max inject rate on either the hub or clamp of the power injectable PICC or CVC. Once the RN attached the contrast tubing to the central line catheter hub it was then that the tech could follow thru with the angio study. Luckily, our techs were very aware of their scope of practice and understood clearly their role so fortunately this has never been an issue for us. After hours the Radiology RN role was handled by either a Radiologist who may still be in the department, the Nursing Supervisor, Rapid Response RN, etc.
I have opporutnity to do teaching in other hospitals where I live and unfortunately have come across many instances where RN's in general are unaware of their responsibilites with central lines when taking their patients to Radiology for either a CT or MRI angio study let alone understanding the resposntibility of the radiology tech. This can become problematic especially if the radiology tech does not fully understand their own scope of practice.
Unfortunately, I was made aware of one case in particular where a Radiology tech thought the PICC was power rated, went ahead and attached the contrast line to the PICC hub, started the angio study and subsequently during the power inject sequence the line burst and broke off in the patient.
For me personally, this is a very serious subject and am glad this topic has come up for discussion.