ED techs to start IVs?

guest769224 · Oct 31, 2014

My ED department has allowed this for years. The techs are arguably more adept at it than the nurses.

With practice it's easy to become good at.

We draw the labs and cultures too.

MissChrissy · Oct 31, 2014

I work at an outpatient GI facility and as techs we start IVs. From my experience of having started on IVs on many people the.. dehydrated, the self-proclaimed "difficult sticks/rollers" ...I've done pretty well. Sure there's an occasion were we need to get another person to help, but there are some patients were the anesthesiologists or seasoned folks miss-multiple times. I don't think there is any reason to fill uneasy...I will say proper training is crucial though.

RN403, BSN, RN · Oct 31, 2014

Here, it is within the scope of practice of our ER techs to start IVs, insert foleys, and etc. It doesn't make me feel uneasy at all. Like a PP said as long as proper training is implemented I do not see an issue. Doing these tasks day after day they become quite proficient and competent with their care/tasks.

zmansc, ASN, RN · Oct 31, 2014

We have some techs that are trained to do so, and some that are not. It's great when you have a tech that is good at starting IVs, makes my job so much easier when I can concentrate on doing the assessments and physical exam, while the tech is doing all the grunt work getting the pt in the bed, hooked up to the monitors, drawing blood, starting the iv, etc. It really cuts the time down dramatically on a complex patient.

If our tech is an EMT-I or above, or has been through the first year of RN school at the local university (and has return demonstrated some number of IV starts, I don't remember the number needed) then they can start IVs. Techs with just their CNA or EMT-B do not start IVs, but some have been trained to do blood draws which helps too.

The fact of the matter is it's a fairly mundane, mechanical skill that most people can master with minimal training and experience. I have had techs who are by far the best IV starters in the house, typically they work or worked on a bus somewhere too, which is why they are so good at it. As for other skills, foleys, etc., we don't have techs who do that, but I think we should. Primary reason why we don't is the turnover of techs is too high. If we paid more than McDonalds does, that might not be a problem... lol

As for policies, I don't think we have anything in addition to what I described above. We do have a policy of xx unsuccessful sticks max, then you ask someone else to start the IV, etc. I think when we have a new grad, or someone who is being checked off we only allow them one attempt per pt. Only our EMS paragods can do EJs, so if one of them is teching some people say they aren't allowed to do an EJ (because their scope is different in house than out), but I've always figured, if they can get me access, then I don't really give a rats behind what job code they clocked in as.

cayenne06, MSN, CNM · Oct 31, 2014

Things like injections, IV starts, catheters. . . these are all just manual skills. You don't need a license to perform a procedure like that, as long as you are properly trained, delegated and supervised. The "protected" part of RN scope is really assessment. So an ED tech shouldn't be determining WHEN to place an IV- that should be a decision made by the provider or the RN's standing orders. But the actual placement? Doesn't need to be done by an RN.

Just like a surgical tech can't decided when a surgery is needed, but she/he is quite capable of closing the incision.

navywifeRN · Oct 31, 2014

Techs in my ED star IVs and foleys. It is a HUGE help especially when we are slammed!!!

brownbook · Oct 31, 2014

Yeah to all the above.

I give up on knowing (or even finding) our policy and procedure manuals, who is licensed, certified, etc., to do what. But we have a tech that is our go to person for a difficult stick!

bvalerio23 · Dec 16, 2014

At both L1 Trauma centers and L2/L3 hospitals I have worked with, techs have started IVs. Depending on the level of intensity the ED runs, some places require us to go over procedure with the Phlebotomy dept, some throw us into the ocean and hope we can swim. I found it helped others in nursing school.

Personally I was terrified to start IVs but after I mastered blood draws, IVs were just a few more steps, and similar skills. Depending on how your tech/RN relationship and workload is balanced, this usually takes a huge load off of the RN.

akulahawkRN, ADN, RN, EMT-P · Dec 16, 2014

IV starts are simply a monkey skill. You don't need to know why the IV needs to be done, you just need to be able to do the skill. It doesn't take a ton of education to learn the skill. Paramedics are certainly educated sufficiently to determine whether or not an IV is needed for their patient population. Nurses are also well educated to determine the same thing within their own patient populations. As a Paramedic, I could delegate the task to another Paramedic who is assisting me or I could delegate that task to an EMT Intermediate that can do the job... freeing me up to concentrate on assessment. If there are techs that can do the same thing in the ED, the same thing goes for the nurses. Patient assessment shows that an IV is needed, delegate the task out so you can continue your assessment.

tachybradyRN · Dec 18, 2014

Our ED techs are qualified and trained to start IVs and perform phlebotomy as well as EKGs. They are very helpful to us. A number of them are better than the nurses at getting difficult lines.

KnitWitch, ASN, RN · Dec 25, 2014

Our ED techs can perform straight sticks for labs/cultures, but can't start IVs for whatever policy reason. Some of our techs are amazing at the straight sticks, and if I have a particularly hard stick I'll ask them to help me find a tiny something I can at least get a 22g in to get a pt. started -- the large bore can come later once I can get someone who's U/S trained to come take a look. But in the meantime I can get labs and a least a few pushes/slow drips started, even through a 22g (or 24g, if it's dire).

Interestingly, at my previous place of employment, techs could do straight caths but not foleys and weren't allowed anything to do with getting bloodwork/access. RNs weren't even allowed to draw labs off the IV line unless it was a pedi patient or a known hard stick -- we had a separate ED lab dept. that handled that. I have no idea what drives these policies but they seem to vary widely by facility.