Why does a hospital need RNs which are unable to do anything else but starting IV's?? - page 5

We... Read More

  1. by   Enabled
    Originally posted by NurseDennie
    I got to be very good at starting IV's. In neuro, you get to practice on the old, dried-up population. Another thing is to use a BP cuff instead of a tourniquet, and sometimes nothing at all in the elderly. If you have it too tight, those older veins just blow.

    I worked in a hospital with an IV team from 6a to 6p. They are the BEST. Never, never sitting in the caffeteria waiting on a call - they get in the office early, set up their supplies and that's often their ONLY break during the day. We were supposed to get all the IV's in that we possibly could, and only call them if we'd tried and couldn't, if we were afraid that our trying would ruin the only site available, or if the patient specifically asked. But you know a lot of people just got soooo busy and called for IV team so she could carry on with everything else.

    Incredible bunch of nurses. Once I was in the cafeteria on my lunchbreak and heard a code called at the main elevator. I ran there, and an IV nurse had been closer and that IV was IN there before more than a couple of other people even were close.

    Another time, one of my patients was going bad, and I only had a 20 gauge IV in him. IV nurse came in and asked if I wanted a bigger site - "I saw people running and I thought you might need me."

    Why in the world would you want people like that putting people on bedpans??? And I don't think the IV nurses should hook people up to setups at the bedside - It would take too much of their time to look for THAT order and check the tubing, etc., etc., etc... Let them do what they are incredibly good at.

    Love

    Dennie
    Dennie, I have to agree with you on the bp cuff or nothing in the elderly. I worked on a chronic respiratory unit and frequently lines had to be started or restarted for aminophylline drips. You could just enter the vein with no constrictive devce and see the blood go throughout the hand when the IV site blew. When I first started in the hospital I had a wonderful head nurse who said 'have you tried it" and if I said no she told me to march right back there and try. As a result I gained wonderful experience and have her to thank for it. In a short time I was starting others IVs. The pokicy was two sticks by one person and two by another and after that the physician had to be called. Most would say try again and hang up and after a while the calls were made only if anesthesia had to be called. I saw anesthesia put a 24 in an elderly man that had skin stretched over the bones if you know what I mean. The anesthesiology dept. can charge $350.00 for the service. Within twenty four hours the site was bad and had to restart. We called the MD as the fluids were KVO and not other medications were being given. He declined our request by saying that the patient was dehydrated and thus needed the line for fluids to slowly be given. We reminded him it was at KVO and he said he didn't need to be reminded. Once anethesia refused to put another in the idiot doc had us sink an NG for tube feedings. This patient was clearly out of it and should have been left alone to die with dignity but the attending wanted to keep him alive I guess for the reimbursement for hospital visits. He never had a visitor and never spoke in weeks. Needless to say this doc still does this with elderly patients and I am glad I am not working there to see the pain of someone who wants to have their death with dignity and not with all kinds of stuff attached. We have to know when to give up on a site and defer to someone who is a better sticker. We usually would share duties. One who had a procedure that they didn't feel they could do would do something for someone else in an exchange. There were colleagues who would disimpact a patient and I would hang blood or start an IV for them.
    Sharing opportunities such as the one mentioned allows nurses to reli ze their weaknesses for their stron points. I had forgotten about the radial under the watch band. We had to get an IV order if we had to use a foot. I can asure you this is even more sensitive an area.
  2. by   Agnus
    What use are they. Thier wt in gold if you ask me. I only which our hospitals here had them.

    When you have nurses like me with limited experience starting IVs they can be life savors.

    There are nurses who are better than me at this but they even have doubts and lack confidence.

    An IV nurse would do nothing but IV and her skills would be as sharp as you could wish for. What a blesssing for the poor patient who has to suffer though idiots like be trying to do a stick while I try t get some skill. My skill will never be that good because IV is not the focus of what I do just one part of it.
  3. by   richard bivens
    Regardless of what "some" nurses (or other healthcare pro's) say, starting I.V.'s is an art that takes alot of time to develop. And not everyone (even with years of practice) has the "knack" or "feel" that one must possess to do it quickly and easily. As most patients these days will attest, I.V. therapist's are a welcome sight to behold after being "slaughtered" by the masses.
  4. by   kimmicoobug
    Starting IV's are one of my favorite things to do as a nurse. No IV team here. Although, if I can't get the stick, one of our house supervisors used to be an IV therapy nurse and will try to get it for me.
  5. by   yoga crna
    Every nurse should be proficient in starting IVs. It is a procedure that is both an art and a science. Get out your anatomy book and review the location of veins in the arms. I always use a tourniquet and check the veins before I even think of starting the IV. If the situation doesn't look good, I wrap the extremity in warm moist towels to help them vasodilate. After a few minutes, I check again and almost always look for the biggest, straightest vein I can find. Since I am a CRNA, I like to use the big vein in the ACF because Propofol doesn't hurt the patient in that vein. I ALWAYS (except in emergency situations or when the patient is already anesthetized) use a local anesthetic (lidocaine 1% without epi) to make a skin wheal with a 30 gauge needle. After I puncture the vein and before releasing the tourniquet, I inject a small amount of the lidocaine into the vein, which helps it dilate so I can thread up the catheter.

    The patients love the lidocaine and say that my IVs are the best they ever had. Most anesthesia people use lidocaine. Most patients hate pain. So why not use it. The was a nice study done a few years ago (sorry I don't have the citation handy) that showed better patient satisfaction with the local anesthetic. It is legal in California for RNs to do this--a specific ruling of the Nursing Board on the topic.

    My final IV rule that I follow and you should too, that is the " 3 stick and then call someone else to start the IV rule" The patient deserves that.

    Even though this is not an anesthesia forum, if any student CRNAs are reading this--when there is a difficult IV stick--after the third unsucessful one, I mask the patient with nitrous oxide 60% and 0.25% isoflurane. Once they are vasodilated, the circulator or surgeon starts the IV. You wouldn't do this on a full stomach patient, class 3 and up and emergencies and you should be proficient in mask inductions. Most patients have had good experience with nitrous oxide for dental procedures and are willing to do it rather than have more needle sticks.

    YogaCRNA
  6. by   ESRD
    Quote from yoga crna
    Every nurse should be proficient in starting IVs. It is a procedure that is both an art and a science. Get out your anatomy book and review the location of veins in the arms. I always use a tourniquet and check the veins before I even think of starting the IV. If the situation doesn't look good, I wrap the extremity in warm moist towels to help them vasodilate. After a few minutes, I check again and almost always look for the biggest, straightest vein I can find. Since I am a CRNA, I like to use the big vein in the ACF because Propofol doesn't hurt the patient in that vein. I ALWAYS (except in emergency situations or when the patient is already anesthetized) use a local anesthetic (lidocaine 1% without epi) to make a skin wheal with a 30 gauge needle. After I puncture the vein and before releasing the tourniquet, I inject a small amount of the lidocaine into the vein, which helps it dilate so I can thread up the catheter.

    The patients love the lidocaine and say that my IVs are the best they ever had. Most anesthesia people use lidocaine. Most patients hate pain. So why not use it. The was a nice study done a few years ago (sorry I don't have the citation handy) that showed better patient satisfaction with the local anesthetic. It is legal in California for RNs to do this--a specific ruling of the Nursing Board on the topic.

    My final IV rule that I follow and you should too, that is the " 3 stick and then call someone else to start the IV rule" The patient deserves that.

    Even though this is not an anesthesia forum, if any student CRNAs are reading this--when there is a difficult IV stick--after the third unsucessful one, I mask the patient with nitrous oxide 60% and 0.25% isoflurane. Once they are vasodilated, the circulator or surgeon starts the IV. You wouldn't do this on a full stomach patient, class 3 and up and emergencies and you should be proficient in mask inductions. Most patients have had good experience with nitrous oxide for dental procedures and are willing to do it rather than have more needle sticks.

    YogaCRNA

    Why not use lidocaine.....???? Because it burns like fire.. And why stick someone twice. I started 18 guage all the time pre op and never used lidocaine and actually list it as a personal allergy because I had it used on me pre op once. The RN missed a great vein because of the wheal she had made and I don't have many good veins.

    The next time I came to pre op as a patient she was angry with me stating that they used it on all their pre ops. I told her I wasn't just another patient. She went to get her supplies and came back with the lidocaine and was going use it until she noticed that I knew what it was.. When she tried to stick me she said ,,"If I had used lidocaine I could DIG for this vein."

    Imagine an RN telling another RN (surgical at that) that she DIGS for veins.

    Please don't encourage floor nurses to use lidocaine.

    Thanks.

    ESRD.. I put in 15's now with lidocaine.
  7. by   yoga crna
    To decrease the burning of lidocaine injection, add NaHCO3 to the lidocaine. I use 0.2 cc to 5 cc lidocaine. Also, use a subdermal skin wheal with a 30 gauge needle.It works great and I won't think of starting IV without local in an awake person. A needle stick with a 20 gauge needle hurts more tnan a 30 gauge. To do otherwise in a non-emergency iv insertion is just laziness in my opinion.
    Yoga CRNA
  8. by   ESRD
    Quote from yoga crna
    To decrease the burning of lidocaine injection, add NaHCO3 to the lidocaine. I use 0.2 cc to 5 cc lidocaine. Also, use a subdermal skin wheal with a 30 gauge needle.It works great and I won't think of starting IV without local in an awake person. A needle stick with a 20 gauge needle hurts more tnan a 30 gauge. To do otherwise in a non-emergency iv insertion is just laziness in my opinion.
    Yoga CRNA

    Well in my opinion two sticks hurt more than one. And many times lidocaine doesn't numb the area sufficiently.. I think using lidocaine is lazy because you just want to "stick" someone arbitarily. Have you ever had lidocaine injected into you?? It burns like fire water. And it hurts.. And I think a 30 guage needle hurts more than an 18..

    In my opinion using lidocaine is a short cut for someone unable to start an IV without inflicting pain.. I use 15's now with out lidocaine on a daily basis.

    ESRD..
  9. by   RN-PA
    Quote from yoga crna
    Every nurse should be proficient in starting IVs. It is a procedure that is both an art and a science.
    That's a great concept in an ideal nursing world, but with nurse-to-patient ratios on med-surg of 1:6-7, PLUS higher acuity patients, PLUS covering LPNs' patients, PLUS computer documentation, PLUS many nurses working part-time, becoming proficient at IV starts can be unrealistic for many of us.

    As I posted much earlier in this thread, I am THANKFUL that we have an IV team at our hospital. At the previous hospital where I worked med-surg, we had to try two IV sticks before asking for help. With more and more patients who are elderly, or chemo patients with poor veins, or mastectomy patients with only one useable arm, if I missed my two attempts, I just lost two potential sites and caused the patient pain from my sticks twice. Because of working part-time, I might only have had to restart an IV twice a month. How was I ever to become proficient that way? The EXPERTS-- the IV nurses-- are better for the patients, and help us to do OUR jobs better.
  10. by   nurseluv9
    I am so impressed by the sharing of ideas here in this thread.That inspires me to learn how to insert IV.Im planning to practice my profession soon as soon as i pass my exam.I just wanna ask if theres a school offering IV therapy or class that i can attend to for short period of time like month?thank you so much in advance and God Bless all the nurses!!!
  11. by   moia
    well I am going to let you all in on a little secret. The IV team is a godsend.
    It is where we can go when we break down. When our back injury prevents bedside nursing we still thank god have the option of IV services. I can still care for patients but I can also stay relatively healthy and I get paid!!!
    The IV services team I am joining has some pretty big responsibilitys, we now start PICC lines and work with Hickmanns and portacaths and we look after the chemo population who have almost no veins left and save the floor nurse the agony of an hour looking desperately for a vein. I know sometimes it looks like IV services does nothing but in my hospital one IV nurse does over 60 sticks a day. All the same day surgery and eye clinic patients need an IV and the nurses are usually pretty overwhelmed with the ridiculous amount of paper work just to get a patient admitted.

    In fact I have now made myself really nervous and I am an open heart nurse, who would of thought that the thought of starting 60 IVs is worse than a 12 hour code?
  12. by   stevierae
    Quote from dianah
    Since our hospital switched to the retractable-needle IV cannula, we've all had to re-learn technique. The rep (HAHAHAHAHA - almost wrote REPTILE!) assured us these needles were sharper, "much sharper than those you've been using." While I wholeheartedly appreciate the protection value of our retractable, the rep's statements translated to: "You won't feel the POP anymore when you hit the vein." As Radiology Nurses, we start 20+ IVs a day in CT, most "first time, every time"- EXCEPT after we switched IV needles! We found ourselves doing in two and three tries what we'd previously done in one. FRUSTRATING for us AND our pts. It was SO HARD to start the IVs without feeling that POP! We even had the rep come out to critique our technique (and we certainly verbalized our dissatisfaction w/product -- too late, contract already signed, etc.) and offer suggestions: What are we doing wrong???? We did improve but it took 2 - 3 months till I noticed improvement for myself. Anyone else have any stories about same??
    I had previously posted this on another thread, but had to comment when I saw this! By the way, the people that teach this IV catheter are not reps--or REPTILES, LOL!! Although the reps are often there, the people hired to TEACH the product are RNs. I take a great deal of pride in knowing that, at least at the facilities where I have taught, the staff becomes fully competent and really likes the product, and they use it correctly.

    I used to teach this IV catheter, which is called an InSyte AutoGuard, made by BD. One can "blow" the vein with the stylet upon cannulation; that is why we teach new users to go in "low and slow."

    Here are a couple of tricks to avoid blowing the vein, that you may or may not have been taught:

    ---Before you start, hold onto the catheter hub where it attaches to the clear flash chamber (just above the button.) You will see a slight notch there. BE CAREFUL NOT TO PRESS THE BUTTON!!!

    ---With the opposite hand, grasp the clear flash chamber at its base, and twist it--NOT THE CATHETER ITSELF-- to the right, a full circle, (360 degrees) until you hear a slight "click." You have brought it all the way back where you started, to that "notch." (The notch is just above the button; again, be careful not to press the button.)

    We taught this step by saying "take it for a spin. " This action will loosen the heat seal between the catheter and the stylet, and allow the catheter to "glide" off the stylet easier. If you neglect this step, the catheter may feel "sticky" when you attempt to advance it off the stylet, and may cause you to inadvertently "blow" the vein when you struggle with it.

    ---Here is the most important step: Remember, your approach should be LOW AND SLOW.
    ---Place your thumb and index finger on the little "grooves" on the side of the flash chamber (created for that very reason.)
    ---Angle the catheter, bevel up, at approximately 15 to 30 degrees above the skin.
    ---Stick, (just enough to get the catheter tip in) stop, lower the catheter almost flush with the skin.
    ---As IAG's stylet is sharper than some of the other brands, and thus cannulation less traumatic, you will not feel a POP as you enter the vein as you do with some other brands--that "pop" with other brands is trauma to the vein from a stylet that is not sharp enough.
    ---It may take a bit longer than some other brands to see the flash in the chamber--but if you have successfully accessed the vein, it will appear. Be patient.
    ---Now ADVANCE THE ENTIRE UNIT--not just the catheter--approximately 1/8".
    ---This is important with ANY IV catheter, to make sure a good portion of the actual catheter is in the vein--not just the tip of the stylet.
    ---Go ahead and thread your catheter off the stylet.
    ---Push the button, stabilize your catheter, put digital pressure above your tourniquet, (this will cut down on "back-bleeding") and pull your tourniquet. ----Dress IV site according to institutional policy.

    FYI: the 22s and 24s have a "divet" cut into the tip of the stylet, which allow you to see a drop of blood IN THE CATHETER before you see it as a flashback in the chamber.

    Another FYI: One of the most common reasons for the complaint of "I got a flash, but the catheter won't thread" is failure to advance the entire unit another 1/8" into the vein before threading the catheter off the stylet--it means that only the tip of the stylet is in the vein, and not the tip of catheter itself.

    I have taught other brands of IV catheters, but I have always liked the BD product--even before the safety button; back when it was simply called an InSyte--because it is SHARP.

    Here is my frustration with teaching IV products, and especially in hospitals that have IV teams: A lot of RNs simply do not want to learn.

    I cannot tell you how many times I have gone to various med-surg units nationwide to have RNs--and this is RNs with 30 years of experience--say to me, with pride, "I have never started an IV in my life, and I don't intend to start now. Before we had IV teams, I would call the house supervisor or anesthesia. It's not my job. Oh, did you bring any candy?"


    When I learned to start IVs, I was a Vietnam era corpsman, and even when I went to nursing school in the early '80s, starting IVs was considered basic patient care. It is an incredibly easy skill to learn, and one does not have to do it every single day to remain proficient. In fact, I take travel assignments these days, often one every two years--but it's not like one gets "rusty" or can't get right back into the swing of things after starting 2 or 3.

    I think IV teams are really great to have for PICC insertions--then again, a lot of hospitals have gone to doing those in interventional radiology--but I think that simple peripheral IV access should be considered a basic nursing skill.

    FYI, at most places where I have taught, the radiology nurses and techs--IR, CT, MRI, nuclear medicine etc--are really receptive to learning, and are really good at IV access. Some of the med surg nurses I have encountered could sure take a lesson from them--especially in attitude!
  13. by   stevierae
    Quote from ESRD
    Well in my opinion two sticks hurt more than one. And many times lidocaine doesn't numb the area sufficiently.. I think using lidocaine is lazy because you just want to "stick" someone arbitarily. Have you ever had lidocaine injected into you?? It burns like fire water. And it hurts.. And I think a 30 guage needle hurts more than an 18..

    In my opinion using lidocaine is a short cut for someone unable to start an IV without inflicting pain.. I use 15's now with out lidocaine on a daily basis.

    ESRD..
    I always use buffered Lidocaine intradermally, with a 30 g needle, as yoga described. I often work in CA. You are simply making an intradermal wheal with less than 0.3 cc of fluid--far less traumatic than getting a PPD! The tip of the 30 g needle is all that is under the dermis, and just BARELY, at that. I have never had a problem with "numbing the area sufficiently."

    When I work in Oregon, some hospitals do not allow their RNs to give 1% intradermal Xylocaine for IV access--God knows why. However, some do allow 0.5 % intradermal Xylocaine, (supposedly does not burn as much) OR they suggest making a wheal with injectable NS. I am skeptical as to why the NS technique would work, but there are those who say it does.

close
Why does a hospital need RNs which are unable to do anything else but starting IV's??