Getting the needle in the vein...Register Today!
This is a discussion on Getting the needle in the vein... in LPN / LVN Corner, part of General Nursing ... I have only been a nurse since March of 2011, and I haven't had alot of experience with IV's or...by WldChrry Jul 9, '12I have only been a nurse since March of 2011, and I haven't had alot of experience with IV's or venipuncture. It's a skill I love to do, but have yet to master. I just started a new job in May, and one of the things the nurses are required to do is give medication via venipuncture-the needle does not stay in the vein, we just puncture the vein and push the medicine directly into the vein, then remove the needle. We are an outpatient clinic, so we do this whenever we have a procedure, which is daily. I just started doing these on my own maybe two weeks ago. At first I was doing ok, but lately it seems like the veins have been infiltrating more than usual, in which case I have to get the doctor and he has to give the medicine. I'm not sure what I'm doing wrong, but any tips would be helpful. Thanks!
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- Jul 11, '12 by iluvivtAre you using a butterfly type steel needle or just a regular 20 or 18 gauge needle? I have some ideas for you but I would like to know the product you are using so I can be more specific. I suspect you are NOT using an IV cannula of some type. Also what IV medications are you administering?
- Jul 11, '12 by jadelpnSometimes it is safer and easier to just put in an IV. I do find it difficult to put for instance a butterfly needle into someone's vein and leave it there to administer a med. A 22 or even 24 gauge IV would allow you to secure the device so that you are not apt to have infiltrate. And it flushes easier, so that you are sure they get all of the med. And you can draw labs off the line if you need to as well. If you are using just a straight needle, without the ability to "draw back" on the line, I would not think it safe practice to not assure placement prior to pushing a med. And a smaller gauge IV (or heck, even a 20 gauge if that is what you need) would allow you to do this.
- Jul 11, '12 by WldChrryWe generally use a 25 gauge needle, and it is not a butterfly. We push a mixture of demerol, zofran and normal saline-usually a total of 5cc. It's a regular syringe as well...
- Jul 11, '12 by Asystole RNMost likely you are not securing the needle in fashion that allows the needle to gently rest within the vein without pressing against the vein wall. Having the needle actually resting against the vein wall can cause the needle to puncture the vein causing infiltration or infusing at a high rate can cause a jet of infusate to actually cut through the vein. High concentrations of medications can be very caustic and damaging to the vessel wall. If you are mixing demerol, zofran, and saline within a volume of 5ml then your medication is VERY concentrated.
As a rule of thumb I do not push a medication without diluting the medication into a 10ml syringe and I only place a single medication into a single push. Generally, each push should take at least a minute to several (depends highly upon the medication and what it is administered for). If it is not taking you several minutes to administer then you are pushing a bit fast. 4mg of Zofran itself should take 2-5 minutes and demerol should take 4-5 minutes.
- Jul 12, '12 by ionatanare you sure you are allowed to do this as an LPN? this sounds an awful lot like an IV push to me.
- Jul 12, '12 by libran1984Quote from ionatan1. I'm an LPN, work in an ED, start IVs and push more meds in a day and rarely see the likes of PO meds.are you sure you are allowed to do this as an LPN? this sounds an awful lot like an IV push to me.
2. Giving any med str8 to the vein is IVP and in my opinion, is most effective/safe when administered through a secured saline lock- especially in those jittery ptaients.
- Jul 13, '12 by ionatanMaybe it varies state to state, but I didn't think LPNs were allowed to do IVPs anywhere. I've only worked in Ohio and PA. Interesting...
- Jul 13, '12 by jadelpnSome states are more lenient on this than others. Some facilities are expanding the role of the LPN more readily. A number of state practice acts essentially say that it is up to the facility what in the LPN's practice they will allow. Massachusetts? No way. (and I dunno there may be a facility in MA that allows this, however, I have not heard of this in this state). And I do think the OP is taking a HUGE risk, LPN or RN in injecting a med from a straight needle into a vein when there is no safety net to insure the needle is in the vein. Putting in an IV would be no more of a poke, can ensure placement, and flushing. But as ionatan pointed out, it is very unusual for an LPN to be allowed to do IV pushes. So I would really see on my state practice act if this is allowed, or in your LPN policy of the facility you work for. It is all fun and games until something happens after you push a med and THEN you find out that it was not within your scope to be doing it to begin with. (and people suddenly develop amnesia and had not a CLUE that you were doing it this way....) Protect your license and get informed. And I also float to a busy ED. I can do many things, but pushing meds is not one of them. Just for my own protection, I would really, really, look at if an LPN can push meds......
- Jul 13, '12 by WldChrryThanks for all the input. I myself would much rather just place an IV rather than doing it the way we currently are, but they have been doing it this way for years here. I understand all the concerns about an LPN doing IV push, but like others have said, it varies greatly from state to state and even facility to facility. There is another LPN working in the clinic where I work, in fact, her and I are the only two nurses. She has been working here for 6 years, and this is the way things have always been done.