We are expected to perform central lines (central venous catheters (CVLs) + vascaths for hemodialysis access) and arterial lines. We often also insert introducers/cordis (for large bore access in massive blood loss) and trialysis catheters (vascath with an additional port for medications). These are inserted under sterile conditions using the seldinger technique.
In order to become credentialed in each individual type of line insertion, you must:
Observe 3 procedures; submit request letter (with yours and MD signature) to monthly meeting
Perform 10 proctored procedures with MD signature (Keep MRNs of patients you perform procedure on and scan in all your documents just in case hospital loses them in future)
Submit protected procedures packet to credentialing comittee
To maintain your credentialing, you must do at least ten a year.
To get permission to start proctored lines:
To get permission to do lines independently once you’ve completed all your proctored lines (submit with proctor forms):
Getting Sterile - how to put on sterile gloves
How to Insert a CVL
As of recently our APPs are also now getting credentialed to intubate. The process is slightly different than the lines we do and is overseen by the airway committee.
You must first complete the basic airway course (2 hours) with designated airway trainer then the Piedmont Difficult Airway Course (2 day class).
After this point, you will need to:
Observe three intubations just like you would for CVLs/alines/vascaths
Submit airway observations for credentialing; wait for approval and let the airway team know
Begin your proctored intubations
Email the airway team after each intubation with:
Equipment used (DL/VL), drugs, proctoring physician, any issues or unique circumstances
Fill out the proctor form above
You must have 20 intubations total: 10 ICU intubations at minimum. Five of these must be an LMA. You will get some time in the operating room at PAH, PFH, PNH in which you can get many of these.
Once your proctored intubations are finished and your proctor forms are turned into credentialing, you will complete a final checkoff by a member of the airway team. It will be done with a simulation mannequin; you will get a proctored procedure review and go through airway scenarios.
Once you're certified to intubate:
You must submit 10 intubations/year to the airway team for the first two years
After two years, you must submit 6 intubations/year