I want to throw something out to the community and please give me your opinion. In a patient with CKD stage 3,4,5 and a PICC is ordered. A floor nurse bugs the nephrologist enough that he orders a line in the dominent arm. The question is: even in the face of a nephro approval, is the nurse liable for insertion of the line because as a vascular access expert, you are doing something that you know could be harmful down the road?. So basically if a Nephrologist feels OK with taking the risk, does that let you off the hook?
I would like to hear thoughts, and Lynn especially from you.
Jack Diemer RN, BSN VA-BC
Nothing done or said by another professional would excuse the inserter from liability. This applies to physician orders, verbal instructions, opinions, etc. Your job is to perform a risk vs benefit assessment and completely document your entire thought process. What type of device is currently being used for dialysis? Is there a fistula or graft already in place? How many venous sites do you have for PICC insertion? What about insertion of an IJ? How long is the infusion therapy required? All of that plus more should be included in your assessment, diagnosis and chosen intervention. But in the case of a bad outcome and a lawsuit, your liability is determine by your actions and the evidence of this is your documentation. 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
Our radiology dept has been placing tunneled piccs in the chest for a number of years. One of the groups that the tunneled piccs are used on are renal patients, in order to preserve the arms. This has worked out very well.
Karen Charnigo, MSN, RN, CRNI