IV's for Hospice

[Turtle in scrubs]

As a Hospice nurse, how often do you have to put in IV's?

[tencat]

Been one for three years and haven't put one in yet. I do take a lot of blood, though.

[txspadequeenRN, BSN, RN]

work inpatient hospice and all my patients have iv's..usually they come with picc, ports or cvc's ...i have had to insert quite a few though....never have taken blood though like the previous poster , no reason to since we are comfort care only....

[Turtle in scrubs]

Been one for three years and haven't put one in yet. I do take a lot of blood, though.

Really? This surprises me. I would have thought it would be the other way around. IV's for those who need pain meds IVP or gtts, and no blood draws b/c you wouldn't be checking anything at that point.

Obviously I'm ignorant in this area. Can you enlighten me?

[tewdles, RN]

I am a field RN and I start IV's with some regularity, as well as access ports/PICCs, etc. I do draw blood fairly regularly as I have patients who are on medications which requires some monitoring...it is what their doc wants and what the patients' want, so comfort care or no, that is what I do.

to Turtle in scrubs...many hospice nurses work in practices which employ SQ infusions for pain meds in the absence of a port...this is generally a safer, more economical, and less traumatic way to deliver these meds than to start and maintain a peripheral IV in the home. Remember that you cannot just leave an angiocath in a peripheral vein forever, particularly in these people who, many times, are VERY challenging IV access.

[Turtle in scrubs]

to Turtle in scrubs...many hospice nurses work in practices which employ SQ infusions for pain meds in the absence of a port...this is generally a safer, more economical, and less traumatic way to deliver these meds than to start and maintain a peripheral IV in the home. Remember that you cannot just leave an angiocath in a peripheral vein forever, particularly in these people who, many times, are VERY challenging IV access.

This makes sense. Since the whole idea is a peaceful end of life I would think pain relief would be the most important thing. It certainly is with my inpatients. But the best way I know to achieve this is through an IV. As mentioned I suppose it just depends on the MD and patient as to how best to achieve the best quality of life they can have in the end. I've heard of, but never seen SC infusions. Thanks for the info.

[leslie :-D]

we have lots of ports, piccs and sc infusions (inpt hospice).

piv's are also done somewhat regularly until it is no longer an option.

while many consider this a painful route, sometimes iv meds are the only ones that'll give immediate and adequate relief...

esp when we're trying different meds that'll work on a pt with seemingly intractable symptoms.

this is esp so for our palliative care patients.

it 'seems inpt is much different than home hospice?

although it seems our home hospice nurses, do their share of iv's as well...

leslie

[tewdles, RN]

I agree Leslie, our inpatient nurses deal MUCH more frequently with IVs than I do in the field...and that is quite alright with me...lol.

Inpatient hospice units and nurses are gifts from God, IMHO.

[rotteluvr31, ADN, RN]

My experience, limited as it is, with IV and hospice is this: in the hospital a hospice pt can have an IV but can receive no more than something like 10cc/hr in IV fluids. If there are any IV push meds they can be given IV. I don't think that hospice pts living in their own home have IV's because the pain meds they are given by family members are either oral (solution) or rectal. So a pt leaving the hospital to go home on hospice will have their IV or picc line d/c'd..

[DLS_PMHNP, MSN, RN, NP]

I work inpt Hospice.

We VERY rarely start IVs. Most of our pts that need access, already have a PICC, IntraJug Cath, o ra Port-a-Cath, etc.

If not, we usually set up a sub-q site to minimize "pokes."

[melsch]

I work in an inpatient hospice and we rarely have IV's. Pain mess are all given orally, sc, or transdermally. The only thing I can recall using an IV for is pamidronate infusion, and once finished the IV is d/c'd, I think this is because IVs are harder to maintain and less comfortable than the sc lines. We rarely use hypodermiclysis for short term hydration, I don't really agree that this is more comfortable, but our docs seem to like it.