TOPIC-Insert wire to SVC vs "Nurse" insertion of PICC with wrie more shallow:
We are having a discussion regarding the scope of practice for nurse-inserted PICCs. Our current practice is "nurse" insertion technique for PICCs, whicih is to pre-measure the patient [neonates to adults], access the vein, insert the guidewire to the axillary area, insert the peel away, then remove the wire and thread the pre-measured, pre-cut PICC via the peel away.
In the past, it was our understanding that nurses couldn't [by state law] insert a wire into the SVC. However, in this day and age, since many PICCs are placed in IR, with imaging available, are nurses allowed by state law to insert the wire to the SVC or desired location the same as physicans who insert PICCs? It seems that with either fluoroscopic or ECG guided tip placement [whicih we are not yet using in children at my hospital], nurses are inserting wires to the SVC as regular practice.
My question is this: Can anyone comment as to the legality of this practice? Does anyone have information regarding state laws on inserting the wire to the SVC or IVC?
I thank you in advance for any insight!
Anne Marie Frey,
BSN, RN, CRNI, VA-BC
Vascular Access Service: I.V. Team
The Children's Hospital of Philadelphia
Ext. 44204
CHOP Cell: 267-253-0703
First thing is anything that is written in any state would not be a "law". Passage of a law would require opening the state nurse practice act, something that is not done for scope of practice issues such as this. When the law is opened, any other professional can be heard at the state assembly and have influence over what does and does not get added/changed, etc. If there were such statements is would be a rule from the state board of nursing.
I don't think that many, or any, actually have such statements anymore. My reason for saying this is the fact that at least 38 or 39 states now use the scope of practice decision tree - a series of 5 or 6 questions that the nurse and employer work through to make their own decisions about what is and is not considered to be within the scope of practice. Most state boards do not address scope of practice decisions other than by this decision tree. A few states still use declaratory rulings or advisory opinions but that number has greatly decreased over the past few years.
A wire advanced to the SVC can be done by nursing as long as they are using fluroscopy. This should not be used blindly at the bedside though. I would not say that many PICCs are now placed in IR anymore. If they are inserted there, it is nursing or rad techs doing the procedure and not the radiology physicians.
I am fairly certain that PA uses decision trees for these questions so you can probably find it on their website. 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
In some states the Nurse Practice act (NPA) does limit the scope of what nurses may do.. Check the NPA carefully. See if it has such language... If not specific, try to work with your organization to develop clear policies to change the scope of what nurses may do - particular to the organization.
If indeed the NPA has such limits, begin the long campaign to change it....Yup.... legally process.
Ann Zonderman, BSN, JD, CRNI