Giving Report and IV Access

MunoRN, RN · Jan 19, 2022

I know it seems petty, but it's my biggest pet peeve in nursing, mainly because I believe it signifies far bigger problems with someone's ability to practice as a nurse.

I'm trying to pass along the big picture issues with the patient, but there's no box for that on their "brain" they've made for getting report, so they aren't listening to that, but they do have a box for where the IV is, so that's what they want to know.

I've got a standard answer for that question at this point; "they have two functioning peripheral IV's, they are the brightly colored things taped to their arms, if you're not sure you could identify a peripheral IV without first knowing exactly where it is then you shouldn't be here".

allnurses Guide · Jan 19, 2022

I learned early on that if the majority of the nurses I report to like report a certain way I try to give it to them. The they stop asking me questions that hold up report and frustrate me.

nursej22, MSN, RN · Jan 19, 2022

I worked with a nurse who actually started charting before she ever saw her patients, saying that she would change anything that was different. She would chart based on what the off-going shift would tell her. I started "forgetting" where the IV was, exactly or what color. I would point out if it was a central line, because that would affect what supplies you needed for a flush or blood draws.

Just now, nursej22 said:

I worked with a nurse who actually started charting before she ever saw her patients, saying that she would change anything that was different. She would chart based on what the off-going shift would tell her. I started "forgetting" where the IV was, exactly or what color. I would point out if it was a central line, because that would affect what supplies you needed for a flush or blood draws.

It used to chafe me though, when they would ask if the line was patent. "Nope, hasn't worked in days, why do you ask?"

NightNerd, MSN, RN · Jan 19, 2022

57 minutes ago, thehipbonesconnected said:

During handoff, in a telemetry unit, the nurses I give report to all want to know where the IV is. What is the point of this? My thought is, it’s either in the right or the left. Probably a 20, and if there was an issue, I would have mentioned it! Yet they all expect me to say location, size and ‘saline locked’. Why??

Well, this week I did get a patient with a #22 in her left ankle! LOL, I was glad the offgoing nurse told me that (even though whenever I went to flush it I kept looking at her arms like, "Where the hell did her IV go?"). Otherwise yeah, I just care whether they have one, if they're cleared not to have one for whatever reason, etc.

I think some people just feel more prepared the more information they have - and then there are those who are just quizzing you for the fun of it. In which case, "Gee, I forget, but they've got one somewhere! Anyway, back to that potassium of 7.6 I was telling you about." Or whatever is actually going on with the patient that truly requires some attention.

BlueShoes12, BSN, RN · Jan 20, 2022

Here's another perspective. I work in PACU and pre-op and always ask about IV access when getting report from the floor. But that's because the requirements for the gauge, number of IVs and placement of IVs vary wildly depending on the surgical procedure. Obviously, someone needs functioning IV access for anesthesia.

You wouldn't believe how many inpatients come down to us with an IV hanging half out of their arm or that's completely infiltrated.

iluvivt, BSN, RN · Jan 20, 2022

As an IV nurse I can tell you that many times,depending upon how the IV is being used' and what kind it is, this is pertinent information and I'll tell you why! There are several types of peripherals now,such as the standard short PIV,extended dwell,midlines and extended dwells that can function as a midline depending upon where the tip is.You need to know the type and length so you can properly assess it.and so you can make certain you are not infusing a vesicant or irritant through it (applies to midlines).You also need to know WHEN it was placed or inserted and how.(traditional or ultrasound guided) .The average short peripheral has an average dwell of about 44 to 48 hours before it becomes symptomatic. If it's been in place for that length of time you know you will need to assess it more frequently .Many of the deeper USGPIVs tend to leak then infiltrate within 24 hours unless a longer PIV was used.The anatomical location of the IV is also very important. If you are administering a vesicant or irritant or a vasopressor,areas of flexion should be avoided and areas with a small amount of tissue.( such as the hand) should also be avoided. If I got report that Dopamine was being infused in a hand vein I know I would be starting a new site.There are many procedures too that require a specific site and gauge, such as a CT scan. As you can see it really is vital information that can very easily be relayed in report. The patient has a 15 cm SL Arrow Midline in the right Cephalic placed on the 25th with the tip just below the axilla and it has a brisk blood return and is asymptomatic. and for a short PIV: The patient has a short 20 gauge PIV in the right mid FA placed yesterday and its asymptomatic.I have more if you need it

MunoRN, RN · Jan 20, 2022

10 minutes ago, iluvivt said:

As an IV nurse I can tell you that many times,depending upon how the IV is being used' and what kind it is, this is pertinent information and I'll tell you why! There are several types of peripherals now,such as the standard short PIV,extended dwell,midlines and extended dwells that can function as a midline depending upon where the tip is.You need to know the type and length so you can properly assess it.and so you can make certain you are not infusing a vesicant or irritant through it (applies to midlines).You also need to know WHEN it was placed or inserted and how.(traditional or ultrasound guided) .The average short peripheral has an average dwell of about 44 to 48 hours before it becomes symptomatic. If it's been in place for that length of time you know you will need to assess it more frequently .Many of the deeper USGPIVs tend to leak then infiltrate within 24 hours unless a longer PIV was used.The anatomical location of the IV is also very important. If you are administering a vesicant or irritant or a vasopressor,areas of flexion should be avoided and areas with a small amount of tissue.( such as the hand) should also be avoided. If I got report that Dopamine was being infused in a hand vein I know I would be starting a new site.There are many procedures too that require a specific site and gauge, such as a CT scan. As you can see it really is vital information that can very easily be relayed in report. The patient has a 15 cm SL Arrow Midline in the right Cephalic placed on the 25th with the tip just below the axilla and it has a brisk blood return and is asymptomatic. and for a short PIV: The patient has a short 20 gauge PIV in the right mid FA placed yesterday and its asymptomatic.I have more if you need it

These are all important factors to consider but the far more reliable source for this information is the original charting on the IV, not the reporting-off nurse's recollection of this information.

The oncoming nurse should find this information relevant, but unless the off-going nurse has information about how the original charting is incorrect or misleading then it's not something to be covered in report. The oncoming nurse will assess the IV access of the patient relative to the therapeutic and diagnostic needs of the patient and this is unaffected by previous nurse sharing exactly where the IV is when that is already easily accessible in the charting of the IV.

iluvivt, BSN, RN · Jan 20, 2022

I see your point Muno but the process you are suggesting is never going to happen where I work.

MunoRN, RN · Jan 20, 2022

5 minutes ago, iluvivt said:

I see your point Muno but the process you are suggesting is never going to happen where I work.

Word-of-mouth and telephone-game 10 shifts after the IV was placed is going to be more accurate than the original charting?

If that's really true where you work then I would agree, the charting system is the bigger problem. Even in the most horrible charting systems I've worked with, including DOS-based programs, would make this possible, so I'm skeptical that the original charting on the IV insertion is really inferior to a nurse's report of the insertion many shifts down the line.

0.9%NormalSarah, BSN, RN · Jan 20, 2022

Eh, I always say what lines I’ve got and where in report. It’s just part of my process as I go through systems, and I am someone that likes to be extremely thorough even on things that probably don’t matter as much. But I also don’t get upset if the off-going nurse doesn’t get specific with me. I just wanna know whether I have peripheral or central access.

ladedah1, BSN, RN · Jan 20, 2022

I never understood why having so many specifics about IVs is such a thing for so many nurses. All I ever care about is:

1) Do they have one?

2) Is it running anything?

If it's a central, I may ask if they know off hand how many lumens it has (so I know how many flushes to bring)... but if they start to look like they have to think about it, I just say No worries, it's all in the chart. Same thing for IVs. If they don't know, no big deal. I'll figure it out during assessment.