A new question has arisen for the vascular access team in the facility I work for. We have been known to inject contrast under fluoro for a PICC line we are having difficulty placing. We also have done it with portable CXR if there is any question as to tip location. Over many years this has been what we thought to be acceptable practice for an RN specializing in vascular access. It is always done with consideration to associated allergies and kidney function. Several of our radiologists have even suggested in certain situations that we inject some contrast for the purpose of getting a more precise picture. One of the radiologists recently expressed some concern with this practice and even suggested we were "practicing outside of our scope of practice performing venograms." An extensive review of our policies and procedures was done only to find that we have no statement either way in regards to this issue. Any thoughts?
I do not think you are doing venograms as I would not equate a contrast injection for tip location to be the same as a diagnostic procedure looking for pathology. But you do need to be practicing according to the rules and regs from you state board of nursing. how does your state board address scope of practice decisions? Learn that process and apply it to this issue. You will need a policy and procedure to guide your practice. Since contrast is considered to be a medication, you will either need an established protocol for using this or a separate prescriber order for each patient. I can understand the radiologist concern about unnecessary exposure to contrast and radiation. Much in the news about that lately. An even better, more accurate method is use of ECG for PICC tip location. This removes the need for xray in 75-90% of patients. 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