I value LVTs and their knowledge and expertise.  I've worked with some that I'd trust more than some doctors I've worked with. That being said, in smaller practices and rural areas, we have very few of these.  It's often difficult to retain them or provide the salary and benefits and caseload the best ones desire.   This leaves us with either very good unlicensed assistants who can't do but so much to help, with us doctors having to place catheters for every procedure, or having to hire an LVT that has a license but not as much experience or skill as we truly need.  On the other hand, I don't think most unlicensed assistants understand the why or the consequences of improper size or placement, so I'm more comfortable with some type of training program guideline being used than with allowing anyone to place catheters.  Just my $.02