Hospitals with IV, or Vascular Access Teams

PICCONE · Mar 27, 2001

Dan

I work in a trama level hosp. in Chgo. We don't have a regular IV team. I manage the PICC line insertion team which consists of 10-12 RNs who place lines on a daily call basis. All of my RNs work full time on an inpatient unit. They are compensated with 1.5 hours of pay for each PICC inserted even if completed during regular shift. Every RN and some LPNs insert periphral IV's. Each unit has 1 or more IV resources RN's for help if needed. This system works for us.

Arlene Cowen RN

[email protected]

freezinginVT · Apr 5, 2001

I work for a 250 bed teaching hospital in NH and we still have an IV team that's alive and well We have 7 RN's/LPN's on during the day (usually a max of 3 LPN's on), 3 on the evenings and 1 RN during the night. We do daily checks of all patients on the med/surg floors (onc, tele, surg, med, ortho, vasc, pedi, neuro) as well as insert PICC's/Midlines. We rotate who carries the "PICC pager" so we all keep up our skills---may get 1 picc on your day or you may get 6. We typically place the PICC's in interventional radiology----WAY EASIER---but sometimes at the bedside if IR is too busy. We will try an IV or PICC 2x and if no go then get another nurse to try the IV and if it's a PICC, a radiologist steps in and is glad to do it. I think that having an IV team is a huge service to the patients. I haven't had a patient ever say that the IV team is useless---I'd rather have someone that's doing it all day do my IV than a nurse that does one every few days. Does everyone use lidocaine? We don't use bicarb in the lido at this hospital but think we should. Unfortunately I think IV teams are a dying breed

ajwill · Apr 11, 2001

I work at a small community hospital about 200 beds. We have 2 IV RN's on days and 2 IVRN"S on 3-11. Our night shift position was recently eliminated. On weekends, we go down to one on each shift. I feel it is a great benefit to staff as well as patients. We are responsible for site checks, starts and restarts(not in ER) Central line care and troubleshooting, PICC, midlines insertions. We also spend about 40% of our time with staff education, inservices, orientation, community programs, etc. I would be interested to know if there is anyone getting reimbursed for this specialty, and how. I didnt think staff nursing could generate a fee for service. I agree that I will always ask for an IV RN if I ever need to be 'stuck" and hope that there is one. I agree we are a dying breed, but with the more specialized lines in todays facilities, a few of us should remain.

3651bht · Apr 12, 2001

Just curious. What do you do when you have to wait for the IV nurse to start. Does the patient have to wait for antibiotics, blood etc. I haven't worked where there is a IV team since 1980 UNC at Chapel Hill had one but we were in another building and rarely used them. Also, how does a floor/staff nurse ever learn to start IV's if she doesn't get the chance. I have my days when I couldn't start one for beans and other days when I can do it blindfolded. The best starts are the one's where the patient says," No one can ever start and IV on me." Probably a 98% start rate on those people for me.... Also, how does not trusting your nurse to start an IV help instill confidence in the patient. Who determines that the IV should be removed. Does the patient have to wait for the IV nurse while the fluid continues to infiltrate into his/her arm... Seems this would be a problem. Who's responsible for the day to day of all those IV's..... Interesting,,,,,>>???

Chuckie · Apr 12, 2001

ohbet · Aug 6, 2001

Why are there Iv teams anyway?

3651bht · Aug 9, 2001

When did IV therapy fail to be a part of total patient care..??... Let's not let anyone take more away from us... We have many excellent nurses who can start an IV because they do it all the time.... We have lost enough direct patient care as it is...

May the sun shine brightly on you and may the wind be always at your back...

**canoehead, BSN, RN** · Aug 9, 2001

I think we are allowing patients to be cut up into pieces, first respiratory therapy, soon IV techs. I agree that a patient should not have to suffer through multiple sticks, but at our hospital nurses with less than one year of experience try once if at all, more experienced try twice, and the supervisor is called who looks and sticks if there is anything she thinks is gettable, after that the CRNA's are called, day or night. The idea of losing accountability for any part of a patients care takes away from a holistic perspective, and leaves us open for lapses in communication that result in errors or things being missed.

In a hospital I used to work at the RN resp assessment was ignored for the RT's even though I would go in hourly on a sick pt and the RT showed up Q4H, for nebs, and didn't listen each time. I think it is a disservice to nurses entering the field if we allow our practise to be eroded. Eventually we will be left with ADL's and coordinating the orders of other depts. Why bother become a nurse to be a glorified maid/secretary.

RNforLongTime · Aug 26, 2001

IV teams are a great resource! The last hospital I worked at had an IV team 24/7. Us regular floor RN's were not permitted to do IV starts unless you worked in ICU, ER, L&D or peds. While I was in Nursing school, located in the same community as this hospital, our instructors told us not to worry about IV starts cause there would be an IV team available.

I now work in a facility that doesn't have an IV team. I have been doing my own IV starts. Needless to say, I am not too good at it, and lately I have been having bad luck with succesful starts. I feel horrible when a pt has to be stuck several times in order to get a site. I wish that we had an IV team where I work. I sure do miss it!

RNPAULIE · Sep 11, 2001

the hospital i work in has an IV team of 6 rn's who cover first and most of second shift. They are consulted for PICC placement and if unable to establish access then interventional radiology steps in. They manage the care of the central line dressing changes and PICC changes, the nurses on the floors are encouraged to do 72 hour restarts although most will wait for the IV nurse. The nurses on the units are responsible for the dressing changes on the TLC's but not restarts. I am a new RN and try to improve my skills by doing my own starts but I work on a Renal floor where some of the patients have very limited access and we can only utilize one arm so the IV team prefers we leave those for them. Our infection and phlebitis rate is minimal because these people are experts in what they do and especially on my floor we are thankful to have them.

OpenHeartRN · Dec 6, 2001

Our IV Team is actually expanding - very exciting!! We are giving the peripheral IV starts and restarts back to the floor nurses, as well as Leave In Place dressing changes. The nurses can still call us for difficult sticks or patient requests. We evaluate EVERY patient on admission to determine needs for PICC/Midline placement from the very beginning of the hospital stay. We follow an algorithm based mostly on medications, but also on diagnosis and vascularity. We are now using the Bard Site Rite and microintroducers for patients who were previously labeled "Not a PICC/Midline candidate". We RARELY refer patients for MD inserted triple lumen CVCs and NEVER use radiology. The IV Team checks ALL central lines/PICC/Midline/Infusaports/etc. daily, and we do the dressing changes. We are a resource for the entire hospital, including outpatients. It is a wonderful service. We also numb EVERYONE over 6months of age with bacteriostatic NS. Never Lido.

Happy Sticking

PS - We finally got recognition and support when we were taken over by surgical services instead of nursing.