ED techs to start IVs?

[montecarlo64]

Our ED is possibly going to train and allow techs to start IVs. Does anyone work where this is going on? Is this within the scope of practice? I feel a little uneasy about this. What are your experiences, policies and opinions? Thanks in advance for all comments!

[cd365c]

Yeah, i am done with my phlebotomy class and can't do this at my hospital on med surg floors. Damn well upset i spent time and money to learn a skill i can't use

[MDMBSNRN]

In my ED, our techs have been trained in phlebotomy and are asked to draw blood. Any tech who is a CNA II can also insert Foley catheters, discontinue IVs (but not insert them), perform routine dressing changes and wound care, and perform a myriad of other tasks. Techs are not allowed to insert IVs, and I doubt that will ever be allowed at the current hospital I work at.

[murphyle, BSN, RN]

IV starts are a "delegatable task" in our shop, and many of our EC techs are frankly brilliant at it. Indeed, we typically assign our orienting nurses to work with an experienced tech for half a shift or so to develop their IV competencies.

We do reserve EJ starts to nurses who've completed a competency training program and been "checked off" by one of our physicians.

[dannygirl04]

I worked as a Tech for 3 years in the ED before I started my RN intern position there. We had to be licensed as an EMT to work there and a lot of my day was spent doing IVs. We were called to other floors a lot to start IVs when the RN couldn't get one. Most of the time we did more of them than the RN ever did. We also did catheters, enemas, vitals, assisted with central line placement, assisted with chest tubes, splinting, and worked with the RNs for things like codes and conscious sedation. We did a lot to help out in the ED. Then they eliminated our positions in the department so now the RNs do everything for their patients with no help.

[Shjnsn]

It's the same for our tech positions here but we add in EKGs, rapid streps and UAs.

[joyful_wanderer]

Our techs do IVs, labs, splints, and sutures. They are really good at it too! Having worked at another hospital where our techs were not able to do as much it can really make a difference! I've been told that it is because the practice under the MD's license at least in our state.

[IVRUS, BSN, RN]

IV starts are simply a monkey skill. You don't need to know why the IV needs to be done, you just need to be able to do the skill. It doesn't take a ton of education to learn the skill. Paramedics are certainly educated sufficiently to determine whether or not an IV is needed for their patient population. Nurses are also well educated to determine the same thing within their own patient populations. As a Paramedic, I could delegate the task to another Paramedic who is assisting me or I could delegate that task to an EMT Intermediate that can do the job... freeing me up to concentrate on assessment. If there are techs that can do the same thing in the ED, the same thing goes for the nurses. Patient assessment shows that an IV is needed, delegate the task out so you can continue your assessment.

Wow,

Couldn't disagree with you more! I truly do NOT believe that anyone should be looking at IV therapy, placement or care, as merely a task. Instead, a complete picture MUST be looked at: Diagnosis assessment pre-insertion, what is the pt's progrnosis, how long is therapy, will the ordered medication be a benign one or is it a irritant or vesicant, What steps should be taken to prevent complications with its placement (infections with placement), can post placement complications be minimized?

To have a tech place an IV catheter in the right arm merely becuase that arm was the closest arm to the tech, or becuase the bedside table was on the right, is crazy. IV placement needs to be so much more than putting the catheter in the vein. Many nurses don't look at these variables, so why should we assume that our techs will... They won't and outcomes will be poor.

[zmansc, ASN, RN]

Wow,

Couldn't disagree with you more! I truly do NOT believe that anyone should be looking at IV therapy, placement or care, as merely a task. Instead, a complete picture MUST be looked at: Diagnosis assessment pre-insertion, what is the pt's progrnosis, how long is therapy, will the ordered medication be a benign one or is it a irritant or vesicant, What steps should be taken to prevent complications with its placement (infections with placement), can post placement complications be minimized?

To have a tech place an IV catheter in the right arm merely becuase that arm was the closest arm to the tech, or becuase the bedside table was on the right, is crazy. IV placement needs to be so much more than putting the catheter in the vein. Many nurses don't look at these variables, so why should we assume that our techs will... They won't and outcomes will be poor.

The statement was "IV starts are simply a monkey task", not "IV therapy is simply a monkey task". Don't confuse the overall job (IV Therapy) with doing a task (IV Start). There are many tasks we have given to techs which are just part of a further job. Yes, the tech can clean up the patient, but the nurse still needs to assess the patient for skin breakdown, etc. A good tech might tell you, "when I was doing xxx, I saw yyy", but it's still your job to assess the patient. You the nurse need to give clear instructions to the tech on any restrictions in how/where/when they place the IV, but the task of placement is very much a task that can be delegated to a trained, competent tech.

Also, your assumption that the tech is going to be too lazy to walk around to the other side of the patient if the other side is the proper place for placement of the IV, or that the tech will not use proper technique to prevent infection and do a good job of placing IVs is quite condescending and rude to the high quality techs who place IVs at my ED. These folks are trained to do a job, and take great pride in doing it well.

The techs I work with who place IVs are some of the best at placing IVs I've seen. They place them per what information the nurse gives them and if they are confused by the orders and what they see, they will go get clarification. It also helps when they are around and we need an IV in an emergent situation, like a code, because we can give them that task and move on to doing another task ourselves confident that the task will be accomplished quickly and correctly.

[IVRUS, BSN, RN]

The statement was "IV starts are simply a monkey task", not "IV therapy is simply a monkey task". Don't confuse the overall job (IV Therapy) with doing a task (IV Start). There are many tasks we have given to techs which are just part of a further job. Yes, the tech can clean up the patient, but the nurse still needs to assess the patient for skin breakdown, etc. A good tech might tell you, "when I was doing xxx, I saw yyy", but it's still your job to assess the patient. You the nurse need to give clear instructions to the tech on any restrictions in how/where/when they place the IV, but the task of placement is very much a task that can be delegated to a trained, competent tech.

Also, your assumption that the tech is going to be too lazy to walk around to the other side of the patient if the other side is the proper place for placement of the IV, or that the tech will not use proper technique to prevent infection and do a good job of placing IVs is quite condescending and rude to the high quality techs who place IVs at my ED. These folks are trained to do a job, and take great pride in doing it well.

The techs I work with who place IVs are some of the best at placing IVs I've seen. They place them per what information the nurse gives them and if they are confused by the orders and what they see, they will go get clarification. It also helps when they are around and we need an IV in an emergent situation, like a code, because we can give them that task and move on to doing another task ourselves confident that the task will be accomplished quickly and correctly.

But again... You cannot seperate the "task" as you put it from the other necessary variables. And, there are many nurses that I've seen, that simply don't look and assess for best access site, so why would the tech? Now, I am aware that some techs may be good at placing an IV catheter, but have they assessed and performed the other needed steps BEFORE that line was placed? Or are you saying that you do all the preliminary work then tell them "go here?" IMO, if I've done all the preliminary assessment work, I may as well put in the IV catheter myself. And, I've seen many techs in an ER setting, which can place a IV catheter with ease, but the why's and why nots escape them. I don't think that I'm being condescending, merely, saying that so much more that is involved with the VP experience than just "sticking" someone.

[ZooMommyRN, ADN, RN]

Our techs are all either EMT or Paramedics, some of them have been starting IVs as long as I've been alive so I have no problem deferring to them.

[Guest03/15/15, BSN, RN]

We have medics in our ER. They are capable of iv and blood draws.

[Guest03/15/15, BSN, RN]

I'm jealous some of y'all who have techs that can straight cath, place foleys, and give enemas. Our emt/tech 1 can do ekgs and blood draws (if they are good) our medics/ tech 2 can do ekg, iv placements, and blood draws. Both are able to assist with bed pans/ urinals ...if they already haven't vanished. Granted, we have good techs and then some we need a different job.