I work on an IV/ PICC team in an approximately 220 bed hospital. We insert about 80-90 PICC lines per month, perform overwires of PA introducers to nontunneled CVCs' for open heart patients prior to being discharged from ICU, perform all dressing changes for central lines, troubleshoot central line complications, obtain difficult IV sticks, supply management, CQI and data collection in conjunction with infection control department, update and maintain work instructions, teaching of IV therapy associated skills to other nurses in our facility, etc. There are 2 IV Therapy RNs' on at any given time. One of us will work 0700-1730 and the other from 0900-1930. We are not a 24 hour team at this time and obviously, are very busy during the day. My actual question is in regards to port-a-cath deaccess. We are wanting to review the work instruction for this skill and change it to reflect that any RN can deaccess. Our team has attempted to educate multiple RNs' in key departments to do both access & deaccess. However, the accessing skill is difficult to maintain as the RNs' do not get enough exposure to feel competent. Therefore, our team ends up doing access & deaccess for most port-a-caths in the facility. Our current work instruction states that an RN can only do access & deaccess after being certified by our team on these skills. There is an entire process for this as well. We find it difficult to be available for deaccess when needed related to our workload. It is not our intention to delay a patient discharge, etc.
This discussion for changing the work instruction has come to a halt until we investigate what other facilities do. What is best practice? Would it be acceptable to allow any RN to perform port-a-cath deaccess? Why? It just seems that if the bedside RN is responsible for the care & maintenance of the port during the patient's stay then he/she should be able to safely deaccess as well. Thank you for any input you may have.
Assigning this task to all staff nurses would mean that their practice is expanding. This means that your facility must have documented competency, both initially and on an ongoing basis, for all that are given responsibility for doing this procedure. See INS Standards on Competency and Comptency Validation along with the huge list of references including Joint Commission. So the question you must address is which method would serve your patients in a better way - documenting initial and ongoing competency with this procedure for all staff nurses or expanding the number of nurses on your team to allow this to remain in the hands of skilled staff. I would peronally support the latter option but you might be able to make the first option work. 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