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I
agree with you that we need to look at new models...I agree that we are in a
nursing shortage...I'm actively looking for options....Would any of you be
willing to share your job description or competency checkoffs for your line
techs? and the state you are in?....I'm receiving significant pushback from
our Board of Nursing related to the "assessment" piece...actually what they are
saying is that the RN is signing off for an assessment that they have not
performed...not that I personally agree...this is just my
battle..
----- Original Message -----
Sent: Thursday, March 02, 2006 7:54
AM
Subject: RE: dressing changes and
protocol/procedures for DVT in PICC Arm
I have been following all
the posting on this issue. To answer a few of the questions--a nursing
technician is a non professional staff member that is overseen by a
professional(i.e.RN or LPN). At our institution their usual responsibilites
are to assist the staff with baths, walks,vitals, accuchecks,secretarial
duties,etc. For our line care tech, they have been specifically trained for
this job. They attend an orientation to sterile procedure in the OR. This is
usually 2-3 full days of placing gowns, gloves on correctly , opening
sterile packages and maintaining a sterile field. They then must be trained
by another line care tech or PICC nurse. This process is usually a couple
weeks. They are taught to look for complications at the site of insertion
(i.e.redness,drainage). If they find this, they will call the PICC
nurse and we will look at the site. They also look for swelling of the arm.
We still do once a week arm measurements. The techs do this and again inform
the PICC team if they notice increasing arm measurements. We the PICC nurses
work very closely with the techs. We still hold the nursing staff
ultimitaley responsible for the assessment of the PICC.
The line care techs work well at
our facility. Our infection rates are extremely low. I attribute this to the
dedication of these techs. I would much rather have 3 specifically trained
techs doing sterile technique that they are very good at it, as opposed to
300 nurses doing varying degrees of sterile technique. One of the biggest
challenges though is the monotony of the job. They are doing the same thing
over and over again. We are fortunate to have some good techs right now.
From: Henderson, Karin
[mailto:[EMAIL PROTECTED]
Sent: Thu 3/2/2006 6:30
AM
To: 'Kokotis, Kathy'; Henderson, Karin ; Ratz, Karen; Helen
lazeration; [EMAIL PROTECTED]
Subject: RE: dressing changes and
protocol/procedures for DVT in PICC Arm
While I absolutely agree that we can teach and that many
techs can fit
nicely into this model, in NC, even LPNs cannot do initial
assessments and
RNsmust assess for any changes in patient status.
But I agree that in the
future, (which is now), we need to push the
envelop to support nursing and
optimize patient care
-----Original
Message-----
From: Kokotis, Kathy [mailto:[EMAIL PROTECTED]]
Sent:
Wednesday, March 01, 2006 5:57 PM
To: Henderson, Karin; Ratz, Karen;
Helen lazeration; [EMAIL PROTECTED]
Subject: RE: dressing changes and
protocol/procedures for DVT in PICC
Arm
Technicians have been
used in the battlefield for years. We could teach
them to assess
better than the staff RN's for redness, drainage, swelling
etc.
Would you rather have staff nurses never do dressings or site
inspections
or techs that are competency trained. I like the idea of techs.
It
fits with the hospital re-design I see for the
future
Kathy
________________________________
From:
Henderson, Karin [mailto:[EMAIL PROTECTED]]
Sent:
Tue 2/28/2006 2:19 PM
To: Kokotis, Kathy; Ratz, Karen; Helen lazeration;
[EMAIL PROTECTED]
Subject: RE: dressing changes and protocol/procedures for
DVT in PICC Arm
I'm very interested in the idea...just
wondering, since "assessment" is not
in the "scope of practice" for
techs, if this is an issue?
-----Original Message-----
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]]On
Behalf Of Kokotis, Kathy
Sent: Tuesday, February 28, 2006 1:45 PM
To:
Ratz, Karen; Helen lazeration; [EMAIL PROTECTED]
Subject: RE: dressing
changes and protocol/procedures for DVT in PICC
Arm
This is
the future - talked about this same concept today in my lecure
This is
how we reduce CVC infections - line teams with technicians reporting
to
the vascular access service
Flow process control at its best
I love
this!!!
Kathy
________________________________
From:
[EMAIL PROTECTED] on behalf of Ratz, Karen
Sent: Tue
2/28/2006 5:36 AM
To: Helen lazeration; [EMAIL PROTECTED]
Subject: RE:
dressing changes and protocol/procedures for DVT in PICC Arm
We
have a line care team that is responsible for all the dressing changes
to
subclavian, jugular, arterial , Hickman and PICC lines. They are
nursing
technicians that perform this task. We have 1 full time and 2
others that
are part time. They perform the dressing change with sterile
gown,sterile
gloves and the large sterile drape,chloraprep, and the
biopatch. They also
wear the mask and hair bonnet. We had 1 PICC
infection last year and 0
central line infections. The technicians also
assist us with PICC insertions
if not busy with dressing
changes.
________________________________
From:
[EMAIL PROTECTED] on behalf of Helen lazeration
Sent: Sat
2/25/2006 2:18 PM
To: [EMAIL PROTECTED]
Subject: dressing changes and
protocol/procedures for DVT in PICC Arm
Need some help with two
items:
Just need an informal survey on how many
facilities have their IV/PICC
Teams do the routine dressing changes or if
the nursing staff do the changes
and how everyone feels about the nursing
staff on the floors doing the
routine dressing
changes.
Also, if there are any facilities out
there who have physicians leave a
PICC in place with a DVT and
anti-coagulate the patient to try and break
down the DVT? If so, do
you have a policy/procedure in place for this
scenario that you would be
willing to share?
Helen Lazeration, CRNI
Fairbanks Memorial
Hospital
Fairbanks,
Alaska
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