CVME Insider: Nursing Knowledge That Matters

Is a Respiratory Therapist (RT) more than just a breathing treatment provider? So I have had experience in nursing for over 20 years and have specialized in Infusion Therapy for over 6 years.  Recently, I was teaching an IV class in which the facility was using a Respiratory Therapist to insert and maintain their PICC's.  I was a little taken aback by this discovery as I have never heard of such a thing. Well I contacted the California Board for Respiratory Therapist and they responded back fairly quick and the following was their response; "Good afternoon Mr. Stansbury. The Respiratory Care Board of California (Board) often receives inquiries related to PICC and central line insertion.   In its responses the Board has stated that that licensed respiratory care practitioners are authorized to insert and care for PICC lines, so long as appropriate training, guidelines, and competencies are provided/documented by the licensed health care facility ...

Intraosseous Devices The recognition of   the   intraosseous (IO)  vascular access  device in fluid resuscitation and stabilization of patients has been underrated for quite some time. Intravenous therapy alone has made significant strides in the past forty years. The need to administer a wide variety of fluids and medications to a patient and affect their circulatory system is critical in the resuscitation of patients in an emergent situation regardless of their underlying disease process. Rapid  vascular access  is required for many conditions to include but not limited to hypovolemic shock, trauma,  anaphylactic shock  and cardiac arrest . There have been several “leading national and international organizations” that have published position statements as well as performed research studies to advance the cause of the IO. The IO has served to change the standard of care in the emergency room in regards to the quick need for  vascula...

Free ECG Tip Placement Webinar by  International Vascular Access Expert Using x-ray to confirm PICC tip placement wastes clinical care time, exposes patients to harmful radiation, and delays medical therapy. The ECG Tip Confirmation Systems available on the market can help alleviate these problems by using an adult patient's cardiac electrical activity to position the tip of the PICC in close proximity to the cavoatrial junction (CAJ). Final tip location is confirmed by the nurse at the bedside and infusion therapy can begin immediately without the need for a confirmatory chest x-ray. In a clinical study, 99.1% of 114 PICCs were placed at the CAJ or within +/- 1 cm using Bard® Tip Confirmation Technology.   "Rare ECG tip placement webinar by international vascular access expert Mauro Pittiruti of the Università Cattolica del Sacro Cuore in Rome, Italy, is being offered free next month to healthcare professionals, in association with Vygon (UK) Ltd." ...

If you have drawn blood or started IV's for any length of time; one knows that you cannot be vain when it comes to your patients veins Veins will collapse or shrink or blow; due to many reasons within our control and some beyond our control. If the provider does not prepare the patient and keep the patient calm the patient may panic. If the provider does not use the right equipment samples will hemolyze. Parents who may be scared will not hold their children and the kids will kick. Difficult venipunctures are simply a part of the everyday task that every nurse working may face. If you think that your day will be perfect every day you come to work and draw blood or start an IV then you are vain. There are so many different patients, illnesses, and other factors that will play into your success at drawing blood or starting your infusion therapy . Drawing blood from drug addicts, obese people, critically ill patients, geriatric patients, and pediatric patients will...

Infusion Therapy: 5 Things Nurses Should Know About CVAD’s   Central Venous Access Devices (CVAD's)   First the nurse must know what a CVAD is and where it will be placed in the patient.  A CVAD is a Central Venous Access Device.  This may be a PICC line , Triple lumen , Groshong , or other type of centrally located vascular access device.  CVAD’s are an essential part of Infusion Therapy and the nurse must learn and understand the differences in the types and locations of the devices as well as the infusates that will be administered through the devices. The following are 5 important topics that Nurses should be aware in relationship to their CVAD: 1.  Nurses must get an order for a chest  XRAY or use an alternative device to confirm Placement of the Distal Tip of the CVAD The distal tip of the PICC line is best positioned in the Lower one thoird of the SVC 2.  Ensure that if using a CVAD that the health care team and fac...