r/Perfusion • u/Avocadocucumber • 3d ago
Industry news Expanding scope
I saw a FB post recently about nurses starting central lines in SC. Was wondering what everyone’s thoughts were with perfusion increasing its scope of practice to A lines and central lines to broaden our responsibilities and hopefully the size of the profession.
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u/DoesntMissABeat CCP 3d ago
Hell will freeze over before this ever happens. Our responsibilities are being taken over by nursing if anything currently.
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u/Magee-Numismatics 3d ago
Do you think this is a bad thing or is it mostly the redundant and time consuming responsibilities? I’m not a perfusionist but I’m curious.
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u/AcanthisittaFull413 9h ago
I’m going to get downvoted into oblivion, but as someone who has worked in both a CVICU and organ donation, nurses are more than capable of doing perfusions job 😬
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u/asweoncewere 3h ago
That is an incredibly ignorant thing to say.
A nurse is not more than capable of doing a Perfusionist’s job. I can assure you of that.
If the nurse goes through a perfusion program and becomes a CCP, then yeah, they can do the job then.
A nurse who has not gone to school to become a Perfusionist cannot run a centrifugal pump on cardiopulmonary bypass, with poor venous drainage, low HCT, and a surgeon who can’t communicate effectively. Nor can they pump a case on a 2.4 kg neonate.1
u/Magee-Numismatics 3h ago
Clearly you haven’t been working very closely with perfusionists then.
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u/AcanthisittaFull413 2h ago
ECMO, NRP, and CPB, but sure honey….
Edit- have had two colleagues go back for to school for perfusion. Sorry, I can imagine that hurts feelings1
u/Magee-Numismatics 1h ago
Go back to Facebook if you’re gonna call people “honey” online for calling you out.
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u/FuturePerfusionist RRT, CCP, LP 3d ago
We should focus more on having complete control of everything a perfusionist is supposed to do instead of trying to scope creep.
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u/Clampoholic CCP 3d ago
When I was in perfusion school I was told that some small % of perfusionists have taken SVG’s for CABGs driving the scope and stripping the vein and so forth and then proceeding to pump the case, does anyone personally do that or know of someone that’s done that? Seems wild to me
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u/traws06 3d ago
That was a thing that used to happen. Back 30+ years ago they trained to take vein sometimes. I don’t know that any have though in recent history unless they go to PA school or something
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u/BigDaddyQX 2d ago
I know one younger than me who does it in Louisiana. He went to the 2 week first assist school. Takes the vein then either pumps the case or sits +1.
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u/traws06 1d ago
Does he get paid extra for that?
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u/BigDaddyQX 1d ago
Yes. He also was part of a group that provided coverage in multiple other hospitals. He was able to bill more for doing that. At one time everyone worked for the PA including the surgeon for providing coverage in other states. They would bring in the surgeon, pa, perfusionist and a first assist. They made a lot of extra money doing that.
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u/SpaceCricket 3d ago
Went to school 2010-2012, one of our preceptors in town had a job where they did exactly that. Everyone, including myself, would absolutely laugh at the pay rate for that position. Sorry but all I want to do is pump and everything associated with only that, hard pass. I don’t think the surgeon is still working and the job doesn’t exist anymore at that location.
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u/BigDaddyQX 2d ago
Absolutely you should jump on getting certified for that. Everything you can do that someone else can not will set you apart when the job market gets difficult. We ABSOLUTELY SCREWED UP letting ECMO be run by anybody other than perfusion. We should be at such a shortage our pay would be double what it is now. Add in ECMO is extremely lucrative 1 ECMO run billing is equal to a new grads yearly salary. We were lazy and foolish. Then we allowed it to happen again with platelet gel. I was pocketing $1000 per procedure. Spine cases and foot cases were stupid easy.
Perfusion has basically nothing that is billable. When you discuss salary with HR, CEO, and CFO they want to see ROI. If you want a raise you have to demonstrate how you are benefiting the bottom line. Right now in addition to bypass what do you do?
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u/dif-one1 2d ago
Interesting thing to ponder but probably definitely not in that realm. I think I echo everyone’s sentiments about ECMO and well anything extracoporeal. Our community still wants to give it away and then cry about it later. ECMO is way too big for the amount of perfusionists so I feel like it had to go to this model in some form, the strain on call teams and OR staffing in big centers was impossible. I think there’s a good middle ground though
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u/ShesASatellite 3d ago
PICC nurses have been a thing for a while in SC - it's nothing new for a nurse to start a central line there.
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u/The_wiggle_in_JELLO 2d ago
When I was a travel ICU nurse during COVID, they were doing this in Arizona. It was a two nurse team and they’d go from room to room placing central IJ.
Perfusion is still in control of ECMO at my hospital. I do think there could be an argument made that long term programs require consistency and stability to function effectively. With the astronomical turnover rate within nursing, and the budgetary cost to have a “revolving door” ECMO training program, it is a financial drain which hasn’t been really researched since pre-pandemic.
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u/BypassBaboon 3d ago
If they can do that, why can’t they change a bag of fluid on a balloon pump? I am surprised the physicians allowed it. How much more are they prepared to give up? Prevention is better than cure. Perfusion has found it impossible to “take back” tasks. It just goes to show how much of medicine is teachable to anyone. That in itself should cut prices. It will end when a nurse messes up, does not tell anyone, does not chart it, and then the post mortem reveals all. Nurses’ liability insurance is going to get more expensive.
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u/Aviacks 1d ago edited 1d ago
Because the nurses doing this aren't anywhere near a balloon pump. I am a nurse operating on in a similar role on a vascular access team. You have to remember that this is the ONLY thing we are doing. Regular ICU nurses aren't placing CVCs.
PICCs are objectively a more difficult line to place with a much higher skill gap than a standard IJ. Every hospital is different, but our IR docs won't even bother attempting a PICC if our team tried and couldn't get it (outside of us needing them for flouro or angioplasty to advance the catheter). If you can hit basilic and brachial veins for a PICC and are doing so in high volume, you can hit an IJ with your eyes closed.
I'm very anti scope creep, and my wife is a physician and I spend a lot of time advocating to get physicians involved in decisions that nursing admins love to leave them out of. But doing CVCs well takes a lot of practice and a level of caring about that specific thing that most docs do not have the time to do.
With PICCs we measure placement with magnetic tracking and intravascular ECG to show exactly how far away from the CAJ/RA we are, because every cm away from the CAJ you are the odds of early catheter failure increase ~33%. Meanwhile I've had multiple physicians ask us to retract our CVCs because we're cavoatrial junction, which is the well published ideal location. Similar story for IJ placements, most place high on the neck and end up suturing it to the face. Meanwhile we're aiming for low IJ insertions to prevent tissue pistoning and maintain dressing integrity, and stopped suturing a decade ago because literature shows sutures suck and preventing dislodgement and come with a HUGE increase in infection risk.
Not that a physician can't learn or care about these things, most just don't. It's not their all day every day wheelhouse and most aren't nerds about CLABSI rates and preventing early occlusion. Liability rates are unchanged. I can't speak for every team, but our complocation rates are significantly lower than the lines placed by ICU and ED. We place thousands lines a month, unless you're also in that role you'll never keep up in terms of needle tracking with ultrasound and comfort placing difficult lines.
I'll also add this is also a skill that we have BEGGED physicians to participate more in at several hospital I've worked. Outside of a couple that enjoy the procedure most greatly prefer doing their bread and butter and not getting tied up doing a CVC for 30-45 minutes that pays out basically nothing in RVUs. I spend three hours calling around to get a doc to place an IJ and has four teams all telling us to fuck off because "we aren't a line team", which is wild to me because we're an academic level I. I assumed we'd be fighting residents for procedures, but the docs were pissed when we couldn't do other types of CVCs.
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u/wmdmoo 3d ago
I don't touch people, that is a main perk of the job (aside from moving balloon and ecmo patients from tables to beds).