Respiratory therapists expand practice with VAT.

Scott Murach, RRT, VA-BC, EMT-B, is always looking for ways to expand the scope of respiratory therapy. So after the Texas Medical Board in 2017 allowed respiratory therapists to start inserting vascular access lines, he saw an opportunity.

“We proposed it to our administration and they were very receptive,” said Murach, a respiratory therapist at Texas Health Harris Methodist Hospital Cleburne. “They gave us the opportunity to move forward.”

At the time, the hospital was relying on an outside company to place peripherally inserted central catheters (PICC) and midline catheters.

Murach took the training in 2018. In addition to being a respiratory therapist and an emergency medical technician, he also has a Vascular Access Board Certification. With the support of hospital leaders and a pulmonologist champion, Andrew Anyadiegwu, M.D., the department built a core vascular access team (VAT).

“We got the support from our administration to free up people from day-to-day operations so they could be trained,” Murach said. “It would have been very hard to do without that support.”

Reducing the hospital’s reliance on an outside vendor saved the hospital more than $20,000 last year alone, said Andrea Newman, M.H.A., B.S.N., R.N., senior director of Quality & Supportive Services at Texas Health Cleburne.

“We still have to call after hours or when we don’t have a respiratory therapist here who has the ability to place those lines,” Newman said. “Our goal is to have someone from the team who can put in the lines here 24/7. We’re trying to increase the training so we can have more coverage.”

Having an internal team brings more than just financial benefits.

“Having our own people place lines also helps us make sure we use the right line for the patient,” Newman said. “Sometimes doctors order PICC lines when they might not need that. Sometimes we can do a midline, which is not a central line. Doing more midlines reduces the risk of central line associated bloodstream infections (CLABSI).”

The vendor places whatever line is ordered, but VAT members use an algorithm from the Infusion Nurses Society to determine the appropriate line for the medication ordered.

Physicians on the medical staff were a bit resistant at first but “once we explained why a PICC line wasn’t appropriate, they understood,” said Kevin Sullivan, CRT, RCP, cardiopulmonary supervisor. “Now they’ll say they want ‘a PICC line or whatever you think is best according to the guidelines.’”

Ajith Pai, hospital president, said Murach embodies the innovative spirit embraced by Texas Health Cleburne.

“Scott’s dedication to expanding the scope of respiratory therapy and his persistence in bringing his vision of an internal vascular access team have helped both the hospital and our patients,” Pai said.  

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