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

rreed · Mar 18, 2003

we do have 1 IV nurse that works durning the day, but I have to say I like starting my own IV's.

I love teaching students how to start IV's. I had a student with me for a while and she got really go at it. Her roation went to another unit to work and her patient needed a new IV in, she said she would do it but the nurse she was with said the pt was a hard stick and they would look at it after lunch. The student didn't take a lunch break and went and did the IV with 1 stick. The nurse was shocked that she did so well and ask where did she learn that, she told them on the Med/Surg unit rotation. Which made our unit look a little better for the moment since we are talked about being the worse unit in the hosp?

Enabled · Mar 19, 2003

In the 3 hospitals I worked over the past 20 years only one had an IV team and it was primarily to check of new hires or incase of an emergency and the floor had already tried. Then the last facility I worked they were pulling charge nurses who wanted to learn how to insert a pic line. That made it worse if the charge had a team. Then there were times when they were called to insert them and by the time they returned it could be quite some time later. I also wonder what they charged the patient if the nurse placed it. I bet since a doc ordered it that the charge would be at his rate. I was in the hospital in December and I am a diabetic T2. I am on oral meds. Well, I got the summary bill and fingersticks alone were $24 each time. The hospital made $400 on fingersticks that the unit staff did but it comes as a pharmacy charge. If I have to go back then I am going to get an order to use my own. I could have had months of supplies at that rate and I was just one. Usually, the unit would have several diabetics of both types.

TinyNurse, RN · Jul 18, 2003

excellent thread! I'm a new grad and the hospital I'm starting at doesn't have an IV team. This thread has given me tons of ideas and hints to be able to start a line!

I was only able to start 5 IVs during school,

I like the BP cuff idea, and the gravity ideas.

Also, I don't know how I'd feel about an IV team, it sounds super! but as a new grad, I think I need to perfect that skill.

Thanks again for all of the advice!!!

Enabled · Jul 20, 2003

Only one hospital of four in the county have an IV team and they end at 10p as they come in early for OR cases to be started if they haven't been. There is a special line called a Pic line that requires additional training. This type of line gives continuous access so that a patient can be taught to give themselves antibiotics at home. The only requirement is that the dressing is changed by a nurse every 3 days according to the policy I had. Another trick is to warm a towel and place it over the side to be used. This will increase the circulation. rate. They also have little pressure packs that get warm when they are activated. They are a one time use. We were also allowed to use a lidiocaine pop. That is 1 tenth of a cc of lidocaine given sq near the vessel to be used provided there is no alergy. This helps to stabilize the vein and cause less discomfort. I have had this done on myself and found that I would rather not have it as it stings more than the entering of the skin is less uncomfortable than the pop. Also, when haning any med ask the patient each time if they are allergic to any med. Sometimes patients remember later but fail to notify the staff.

A word of wisdom is "When in doubt wash your hands" If you are unsure of how to do something even if you have done it before washing your hands gives you time to pull the thoughts together and the patient thinks your washing your hands. OR if you don't recall tell the patient that you forgot an item needed and go look up the procedure quickly or ask a colleague you trust. Then with some item in your hand return to the patient's beside with your new found knowledge. You could also ask your patient if someone else can observe and have a regular staff member present. Most patient's don't mind especially if a teaching facility. Some argue whether or not you should tell a patient it is the first time you have done something. That will be for you to decide in each situation when it is the first time based on the patient. Some patients do not want someone making them the guinea pig.

A warm welcome to the profession that so many of us have come to love. With all you hear about the shortage and all read or listen to with a grain of Na Cl. The shortage of numbers are real but it will be up to employers to come up to the plate and make some overt offers to make nursing a priority and not just an expense and numbers of people. Here in Florida the teachers are now getting a salary at entry level, considerably higher than that of nurses. You will be able to choose the position you want and where you want it for the money you want.

If you are eligible for tuition reimbursement related to the shortage legislation take full advantage of it. I would recomment working a year before going onto the next degree level. Get all the education you can. The more educatiion and experience will allow you to go many places unheard of previously with nursing as a possibility. Nurses are doing case management, outpatient surgery staff so that there is every weekend off. Take your time to decide what is best for you and your family if you are married.

Good Luck and Welcome to a wonderful professioin.

Enabled · Jul 20, 2003

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.

Agnus · Jan 12, 2004

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.

richard bivens · Jan 26, 2004

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.

kimmicoobug · Jan 27, 2004

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.

yoga crna · Feb 14, 2004

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

ESRD · Feb 16, 2004

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.

yoga crna · Feb 18, 2004

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

ESRD · Feb 19, 2004

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..