CNAs starting IVs

[BSMSCCRN]

I am a retired Critical Care RN and was recently hospitalized for 5 days in Northern VA. I had 3 IVs and all were started by CNAs. All 3 went bad within 24 hours. Worse yet was that 2 were in my the AC veins. I have never experienced that before. I cannot believe that an RN task like this is being relinquished to CNAs. I am certainly not impressed with their skill. Is this becoming a common practice? And has their scope of practice changed?

[HealthCog]

1 minute ago, HealthCog said:

The last time I had an IV in, the RN butchered me. Finally the phebotomist popped in to get my blood, only to find that access wasnt there. She took the tray from the nurse and had the line in 1-2-3.

I should add that while I am not a nurse, the hospital system I work for regularly uses PCT staff who are properly trained to start IV's as well as remove them.

[techitalia, EMT-B]

Hi, I am an MA/EMT-B.. I have just starting doing IV's for fluids at the urgent care clinic where I work, under our MD clinic director. I also was given the opportunity to start IV's in the field on our volunteer fire dept, under our FD/Chief/EMT-P. It's definitely a skill and task that many do not wish to do. My last IV start failed due to my lack of practice in the field, nerves and too many lookers I suppose. I was very discouraged . I know of many MA's that are starting IV's in clinics now, under their physicians, etc.

[KarenMS]

Starting IVs is a task; I have NO issue with CNAs being trained in that task. I’m an ICU RN and some of my IVs go bad fairly quickly ?‍♀️ Its the RNs job to assess them and that won’t change.

Its really not that special of a skill that we have to hold on to it for sake of pride or whatever.

[NormaSaline]

All aspects of IV therapy, including insertion, I believe is a special skill that we as nurses should be as practiced at as possible. At the same time, I know that all kinds of different personnel in the hospital setting are allowed to start IVs. As long as they are competent and trained, I have 0 problem with that.

What I really agree with the OP about is that it seems to have become a degraded skill, at times almost an afterthought. For example, I recently went in for a procedure, the young nurse was using horrible technique, but I did not want to be "that patient" and complain about every little thing she did or didn't do. In the end I did make one or two comments. The second site she tried was dangerously close to the wrist area, but not in the crease, so I didn't fuss. I came out of the procedure with the IV on the opposite hand. No explanation. Nothing. That's what I'm talking about.

I have no doubt that clinics and hospitals with dedicated IV teams have excellent success rates, with reduced complications such as infiltration and infections. Not to mention patient satisfaction.

[optimis]

Certain techs at my hospital are allowed to start IVs and most are excellent at them. I am good at IVs and I do not consider myself a fool or lazy for delegating that task. We do have an IV therapy team, but they are for PICCs, midlines, central line dressing changes, and difficult sticks after 2 people have attempted. It takes at least 3 hours after a request is made for them to arrive. I would assume if you are needing promethazine and Dilaudid that you would not want to wait 3 hours.

I am mildly surprised you have never had an IV in your AC before. I am more surprised you were given promethazine IV. My hospital has discontinued that practice because it is such a well known vesicant. We now only give it as a deep IM injection. When we did give it, it was diluted in a 100mL bag and given over 15 min. If you were given an IV push of promethazine with no fluids running, no wonder you had burning and IVs going bad!

[Mkakids]

We were not even taught IV starts in nursing school - its definitely not an RN only job.

[scribblz, BSN, CNA, LPN]

Most of the the hospitals in my area (central MA) utilize IV teams made up of 1 or 2 RNs. They put in the majority of the IVs, and check them daily. Other people cleared to start lines are EMTs, ED nurses and floor RNs who've been cleared by the IV team. I personally don't think it's a good idea to delegate it to non licensed personnel because they don't have the same degree of liability we do. I'm not saying there aren't excellent techs out there who could be trained to do it because there are always exceptions. But we are the ones using and supervising the lines...so I feel more comfortable if we are also the ones putting them in.

As to the OP's experience, I'm so sorry you went through that! In my experience 24 hrs is certainly a short lifetime for a correctly placed AC line...so it does call into question the IV placement technique...and if the medicine was at fault then it's really a shame they couldn't place a midline or some other kind of more reliable access. Either way good for you advocating for yourself and others by reporting your experience!

[Just me.]

I work in a hospital. The Nurse techs/Cna start many ivs, even ultrasound guided ivs with special training, this in the ED. On the other units, they do not. Some of the techs are better than some of the nurses, including me at times.