Can a medical assistant or LPN access implanted central venous catheters? The private practice I work at only allows RNs to access/deaccess, but a new hire says she is competent from a prior job. I am right to be concerned about liability?
Dear Nancy replies:
For openers, one’s declaration that one is competent to do a particular patient procedure is not what counts in a situation. What matters is evidence that the competency has been evaluated and documented in some way. Did the new hire take a required certification course for this procedure? How many times has the access occurred? What did the LPN do once the central venous catheter was accessed? With the new hire’s permission, getting input from her former nurse supervisor or DON would be one important way to document competency.
A second issue is whether the state nurse practice act and/or rules allows an LPN to access central venous catheters and, if so, what they can do and not do. Some states do allow LPNs to have increasing responsibilities with such patient care procedures and some do not. Some allow such a procedure, but only with direct supervision from an RN. Others may not require direct supervision.
A careful reading of the act and rules would be necessary. If there is no clear answer from a review, contacting the state board of nursing through its website or, if available, submitting a question to the board for a response, would be important. A third resource would be your facility’s risk manager. What is his or her information on this issue?
Fourth, it would be highly unlikely that a medical assistant would be able to perform this function. Medical assistants are what their name implies: they assist in the care of patients doing basic patient care tasks, not complicated nursing responsibilities that take nursing judgment, skill and training to perform.
Clearly, if you are not certain this access is something the LPN should be doing, after assessing his or her competency and scope of practice, the bottom line is the LPN should not do so.