We are having a new cardiologist coming aboard and he is requesting 2
antecubital IVs be inserted prior to going for pacemaker insertion. Anyone
know the reason behind this practice? Thanks, Dee
From: "Lynn Hadaway" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: Re: [vascular] Ultrasound certification revisited
Date: Tue, 2 May 2006 11:29:58 -0400
Any nurses coming into your hospital representing a manufacturer can not
touch your patients because they are employed by or contracted by the
manufacturer. The state license is important but who is paying them is a
critical issue in whether they touch patients or not.
Regarding your chances for a lawsuit, no one can answer that question. That
totally depends on you, your clinical decisions, and the level of risk you
take when making certain decisions. For instance you could persist in
making many venipunctures to access the vein using US and cause nerve
damage. So the factors that would be considered by an expert would be the
number of attempts you made, the amount of times you passed the finder
needle, your expertise in identifying structures on the US, and your
response when the patient complained of pain - did you keep going and
ignore the patient complaints or did you abort the procedure? As long as
you make wise clinical decisions based on your assessment of your knowledge
and skill, you should lower your risk of a successful lawsuit tremendously.
Nurses get into trouble when they don't know or ignore their own
limitations and make clinical decisions based on a total lack of knowledge
or they ignore patient complaints.
Considering that it is reported to require about 50 attempts with US to
feel comfortable with it, there is no way that a manufacturer or an
employer could support all nurses through their entire process of attaining
competency - the cost would be too great. So we must try without a
preceptor on some of these.
Also, it is not the responsibility of those outside contractors to state
that you are or are not competent. This is the responsibility of your
employer. So document your attempts, learn from each one and soon you will
be proficient. Lynn
At 7:36 AM -0500 4/28/06, Alma Kooistra wrote:
The messages that passed through yesterday re ultrasound certification got
me to thinking........
I am crippling through the process of mastering PICC placement using
ultrasound. My training has consisted of having Boston Scientific send
down
a couple of Ultrasound trained nurses who accompanied me for one day.
Neither were licensed in our state so couldn't touch anyone and just
coached
at the bedside. They watched me during one insertion and a couple of our
other staff during one insertion as well. I had never seen a line placed
using ultrasound until the day I did it with them (and it wasn't
easy.........).
Since that day I have been out there struggling to get through the
learning
curve on my own. I've read P/P for line insertion using ultrasound ad
nauseum. Beyond that I've had no other training.
How well protected am I in case of a lawsuit? I'm starting to get a
little
nervous. I could hardly expect the staff who watched me though that one
first insertion to sign me off as competent......they would be crazy to do
that since I clearly was not competent. I have another trainer coming
next
week. Is it possible that this amount of training would cover me if I
have
a bad outcome? I don't know if there's anyone in our area (South Dakota,
Northwest IA) placing lines at the bedside using ultrasound so it's not
easy
for me to get training. My managed chuckled when I asked about getting
$$$
to go somewhere for training.
Alma Kooistra RN, CRNI
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--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
