RPAs can perform venous access procedures competently

Radiology practitioner assistants can perform image-guided venous access procedures just as safely as do interventional radiologists, IR fellows, and residents, according to a study in the August issue of the Journal of Vascular and Interventional Radiology.The booming popularity of minimally invasive treatments has put a strain on interventional radiologists' workload. The use of image guidance to perform venous access procedures has helped reduce morbidity and mortality, and it represents an important part of daily interventional radiology practice. RPAs could help IRs become more efficient by taking on these relatively straightforward procedures, said principal investigator Joseph Benham, a radiology practitioner assistant and clinical instructor at the University of Arkansas for Medical Sciences. "By doing venous access procedures, RPAs can allow radiologists more time to teach residents and focus on more complex, sophisticated cases that have higher risk factors," he said.Benham and three University of Arkansas radiologists retrospectively reviewed all ultrasound- and fluoroscopy-guided venous access procedures performed at their IR department during one year. They compared the complication rates associated with these procedures as performed by 12 radiology residents, two IR fellows, four IR faculty members, and one board-certified RPA with two years of university training. The investigators found that a properly trained and monitored RPA performed venous access procedures with complication rates similar to those recorded by IR faculty, fellows, and residents (J Vasc Interv Radiol 2007;18[8]:1001-1004).Researchers reviewed a total of 2093 venous access procedures, including placement and monitoring of central and peripheral catheters, change of catheter access, placement of venous ports, and venous explants. The RPA performed 670 procedures, while residents did 570. IR fellows and IR faculty performed 562 and 291, respectively.

Major and overall complication rates were recorded:

• RPAs: 0.29% (major) and 0.89% (overall)
• IR faculty: 0% and 1.71%
• IR fellows: 0.35% and 1.06%
• residents: 0.52% and 1.39%

The difference among the groups was not statistically significant (p = 0.7).

The competence and scope of RPAs' work remain controversial. The perception that RPAs might be short-cutting the system is mostly unfounded, however, and persists only among those who have not worked with these technologists, Benham said. Turf issues represent a genuine concern, but current regulations, particularly at the state level, prevent RPAs from going outside the field of radiology or providing radiology services. RPAs' main purpose is not to set up independent practice but to help preserve radiologists' turf, according to Benham."My goal for doing this study was just to show radiologists and other subspecialties that we can safely do these procedures as long as we are monitored appropriately," he said.For more information from the Diagnostic Imaging archives:

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