This Friday, attendees will fill the room at an AARC Congress pre-course in Tampa, FL, to learn more about developing arterial and vascular catheter insertion programs that utilize RTs. Two RT managers who have already implemented vascular access programs say therapists are well positioned to take on the insertion of these lines.
Chuck Ramirez, BA, RRT, first took the plunge into vascular access 16 years ago when he launched an RT-based PICC program at John C. Lincoln Hospital-North Mountain in Phoenix, AZ. “I published the results of that program, which gave it some legitimacy,” says the AARC member.
When he left Lincoln to build an RT department from the ground up at the newly opened Banner Estrella Medical Center in Buckeye, AZ, he pitched the idea of using RTs to handle PICC lines to his new bosses and they took him up on the offer. “After two years, the PICC program was so successful I was able to leverage it to the insertion of all central lines,” says the manager.
Ramirez keeps track of the program’s outcomes via records maintained in a secure database and periodically performs a quality assessment on the data. Results show the program has resulted in a significant decrease in the wait time for any CVC, an extremely low mechanical complication rate, and a decline in the CLABSI rate across all catheter types.
Benefits have accrued to the therapists on the team as well. “The therapists are allowed to practice at the top of their scope, which is fulfilling professionally,” says the manager.
News of Chuck Ramirez’s success with vascular access at Banner Estrella eventually made its way to other Banner facilities, and when administrators were preparing to open another new hospital in Mesa, AZ, they approached Keegan Mahoney, BS, RRT, about advancing the RT’s scope of practice with the insertion of PICC lines there too.
To get him up to speed, they sent him to learn the fundamentals from Ramirez and his crew at Banner Estrella.
“We adopted his program and opened a new Banner facility with an all RT based Vascular Access Team in 2007,” says the vascular access specialist. Two years later the department added CVC insertions to its list of competencies, training that time under the direction of a physician at a simulation center.
By 2011, RTs were so highly regarded in the area of vascular access that the hospital’s surgeons and interventionists asked the department to take on acute CVHD lines as well.
Like his colleague at Banner Estrella, Mahoney regularly collects outcomes on the program and says that with standardized insertion, maintenance, and removal of central lines by a small group of vascular access specialist RTs, patient safety has improved, long term complications have dropped, and patient and staff satisfaction have skyrocketed.
“It has been an exciting journey developing the program,” says the AARC member. “I can only hope that more respiratory professionals will move towards expanding their scope of practice in the state where they practice.”