IV infusions with only peripheral sites new admit

  1. So i am about 6 months into my RN critical care residency as a new grad on my own. I am finding the following to be frusturating. 1. the reputation of doing a skill is not always. Available, such as IV's. 2. I have difficulty starting new IVs, i do try, but than end up having to rely on fellow nurses for help
    Here is an example... I had a patient who arrived with only 2 peripheral ivs. Nrw orders. Propofol, amio, sodium acetate, levofloxacin, and flagyl. I know to look up compatability, but when items are not compatible in the same line i feel like i get flustered. I will at that point reach out for help. When i receive help, some are understanding others make me feel like an idiot, as if I should know how to connect the infusions all together. I know how to do a secondary line, i know that you can have 2 different infusions in tbeir own channels and than connect at the port below the pump and that the meds must be compatible, but because i am new i need time to figure out the organization and worry that my mind just does not think,quick enough to be in the. Icu
    The seasoned nurses know right away.
    Is their anyway to,improve?
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  2. 5 Comments

  3. by   CCU BSN RN
    1. Use your time off to look up y site compatibilities on whatever tool your hospital pays for. You'll fast learn that K and Mag are compatible, heparin and nitro are compatible, Lasix is basically never compatible with ****, and anything milky like propofol shouldn't be mixed without checking but in a pinch, if you put things together and no precipitate forms...it's probably fine (In this context, 'in a pinch' is code for 'basically coding' or 'about to die', so don't just toss things together on a regular basis)
    2. Experience. For both the skills and the knowing what goes together. Your colleagues no doubt wish you were a pro at everything so they never had to help you, but I think of it like this: If I wasn't here, they'd all be tripled, so is it better that they waste 15 minutes helping me or waste 4 hours taking care of another patient all day/night?
    3. Try placing an IV on every patient before you call someone else in. At least get a tourniquet and look around for veins for a bit. Your co-workers will be more sympathetic if it looks like you've already tried, and will also be grateful if you already have everything they'll need for the IV start in the room waiting for them. Also, spread word among your co-workers that you need practice with vascular access. I did this and everyone started calling me to start their easy IVs on young guys with pipes when they were ready to de-line people, or when they're intubated/sedated. I stick every sedated patient I have at least once for an IV/phleb overnight just for practice. And I went from 5% success to 95% success in a day; like, one day it all clicked and I became pretty damn good. It'll click but you need practice when you're not stressed and distracted and when the patient isn't super unstable.
    4. Make sure you're helping your colleagues as much as possible with the things you CAN do. Help them turn people, bathe people, grab meds for them if they can't leave their patient, draw their labs off central lines. Try to trade tasks instead of making them take over yours with nothing in return.
    5. Don't give up. You're new, it's hard, the sheer volume of new information you're having to learn right now is enough to drive anyone crazy. Your co-workers most likely understand and don't mind helping you, but ICU nurses are not notorious for being warm and fuzzy and nice to people's feelings, by sheer nature of the job, so don't take their cold shoulders personally.
  4. by   Castiela
    Generally speaking, sedatives are compatible with sedatives, hemodynamics drugs are compatible with hemodynamics.

    I'm personally suprised the patient didn't have any central lines. What happens if he needs Levophed?
  5. by   MikeyT-c-IV
    Quote from CCU BSN RN
    Also, spread word among your co-workers that you need practice with vascular access. I did this and everyone started calling me to start their easy IVs on young guys with pipes when they were ready to de-line people, or when they're intubated/sedated. I stick every sedated patient I have at least once for an IV/phleb overnight just for practice.
    Definitely this! When I was a new nurse my colleagues came to me for every IV start. I quickly developed my skills and since has served me well with my career and choice of specialty.

    Nearly all of the patients in our ICU has a PICC/CVC so the bedside nurses do not frequently start IV's. Can you go to a same day surgery setting to practice? We commonly do this to help our nurses develop IV skills.
  6. by   AceOfHearts<3
    Quote from CCU BSN RN
    1. Use your time off to look up y site compatibilities on whatever tool your hospital pays for. You'll fast learn that K and Mag are compatible, heparin and nitro are compatible, Lasix is basically never compatible with ****, and anything milky like propofol shouldn't be mixed without checking but in a pinch, if you put things together and no precipitate forms...it's probably fine (In this context, 'in a pinch' is code for 'basically coding' or 'about to die', so don't just toss things together on a regular basis).
    Protonix isn't compatible with anything either. So glad we went from protonix mixed up by pharmacy in 50ml running over 30 minutes to reconstituting it ourselves and doing a 10ml push over 2 minutes.
  7. by   PeakRN
    The best way to get better at IVs is to do more of them, especially with nurses who will give you their tips and tricks. We have ICU and PICU nurses come down to the ED to practice IVs all the time.

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