Is it within scope of nursing practice to remove a central line?

[mommy22pumpkins]

I just accepted a new position at a small community hospital due to the economy and a recent (4 months ago) job loss. I was inserviced at orientation as to how to remove a central line (subclavian, jugular, or femoral). And am now expected to take them out routinely. I have never witnessed this procedure performed by nurses and I am uncomfortable as the risk of complication is there and I think thats the whole purpose of the doctor removing them is in case something goes wrong.

Does anyone have any experience with this. Do you think I am jeopardizing my license by doing this as I know it is not something they touched on in nursing school (albeit that was 13 years ago - yikes!)

Thanks for any advice/ info you could give me.

Danielle, RN

[OBNurseJeanne]

From what I understand it is in your scope of practice but only if you have been trained. You might want to read up on the procedure if you feel you don't know enoough about it. There is a discussion on AllNurses.com about it. Here is the link:

http://allnurses.com/general-nursing...re-168718.html

[RyanRN]

We routinely removed central lines - as long as it's covered by your particular hospitals' policy I don't see why not. ( all my patients were on cardiac monitors), read your policy.

[RyanRN]

HAAHA that's so true Noodle, I forgot that part! - didn't think of that Danielle - they do a good job too!!!

[PWhite]

As I understand this kind of situation, if your hospital has a policy and procedure in place and has affirmed your ability to perform this procedure, then you can do it.

The Big Thing to remember always is to continue to apply pressure at the exit site to prevent sanguineous leaking. In addition, one should always inspect the length and end tip of the catheter to be sure that it was removed intact.

[copperrose]

Had a pt. halfway remove her internal temporary pacer before. Pulled everything about 1/2 way out, tried to hand it to the 7 pm nurse, and said "OK I'm through with it now." Weird thing is her family was sitting in the room the whole time. Dr. said she was confused because she needed a pacer. Yea right.

She got a new permanent pacer that night. (Dr had to get off his behind and come in at 2000 to put it in. Poor baby)
You work with seniors for 20 years, you begin to see confusion as a way of life. (I know Noodle and Confed think I'm confused anyway because of my politics but thats OK)

[Edson!]

We pulled them all the time in adult CT ICUs--the very ones we'd been using from OR since post-op to float to POFT, get PCWPs, and then shoot outputs.

Take CL's out in ped but not RAs or LAs. CTS deals with that.

It's all about the unit's approved policy.

In adults unit nurses do it all the time. Clean, take suture out with kit, D/C line carefully, hold pressure for appropriate amount of time, take note of what site looks like and apply approved dsg aseptically.
Just have someone go over the procedure w/ you as you do it according to unit/floor policy--and then document carefully.

[Edson!]

Yes, it varies.

Personally I am OK with turffing some stuff to CT fellows/residents, etc. I remember one pt that had an open chest and continuous irrigation going on--and then they still wanted us to take up the patch and directly irrigate and maniplate on to the heart. Legally that always made me nervous. I say let people that are more covered to touch those organs internally do it. When something goes wrong it means somehow they could include me in the possible mix.

Now in a pinch, I'd be OK with open, directly cardiac compressions if there was no one else or had direct supervision; but heck if I'm going too far internally into anything without the proper training, supervision, and protective coverage simply for maintainence or experimental things. Screw that. Let the residents and fellows deal with that--they are better prepared for it and better covered for it.

If working as IV MS or res., I'd have senior resident or fellow to guide me etc, and I wouldn't be working on my own license. Heck, I'm not even an OR nurse.

Egads, as a nurse you are so spread out in all kinds of idiotic and different, ridiculous directions at times. If my focus was different and I was as noted above, I'd be more OK with meddling with internal structures directly. As a RN that's not an RNFA, I'd want to be super careful.

I need my NL until I'm done school, so if anything seems questionable to me, I tend to go to what will get better legal support and coverage.

And in surgery, everyone is super concernned about their M&Ms. I want to limit how much dumping of responsibility for these is pushed on to me.

[springsong]

In my opinion, if it is indicated in your policy then you can discontinue a central line. In my facility, nurses discontunue central lines. But at the same time every year during our critical care day, this skill is included in our annual competency check off to ensure that every nurses working in ICU are competent to do this type of procedure.

[thompd]

It is within your scope of practice. I work in the ICU and we routinely remove central lines. However, we have a procedure in the hospital manual describing how its to be done. This also protects us legally. If you are uncomfortable doing it, check for a procedure within your place of business. I would also ask to have someone help or watch me the first couple of times I perform this task to reassure me that I was doing it correctly. If you don't feel comfortable let someone know, before it does become a problem and possibly cost you your license.