Giving Report and IV Access

[thehipbonesconnected]

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??

[DavidFR, BSN, MSN, RN]

15 hours ago, 0.9%NormalSarah said:

 I just wanna know whether I have peripheral or central access. 

Spot on.

I know my right from my left and I can tell straight away if my line is on the right or the left. It's not as if I'm going to try and get a flush into the wrong arm if the preceding nurse didn't tell me left or right.

I've realised after many years at this game that the kind of nurse who will ask you if a peripehral IV is in the left or right arm is the kind of nurse who when you say "he's apyrexial" will ask "at what temperature?" as if it makes a difference if it's 36.8°C or 36.9°C (or to you guys on that side of the pond, 98.4°F or 98.5°F). In other words, insecure nasty b***** who either want to catch you out or just show off to you that they're supernurse and you're not.

My only exception will be in somebody who's had an axillary clearance or some other reason you can only use one arm: then I'll say, "I sited the IV in the left arm, we can't use the right because......" In that case it's relevant. Otherwise, I don't bother my head and concentrate on handing over the important details instead.

[Music in My Heart]

On 1/18/2022 at 9:10 PM, thehipbonesconnected said:

During handoff, in a telemetry unit, the nurses I give report to all want to know where the IV is.

I'm an ED nurse and I get so tired of them asking this question. Usually I respond with, "I don't know" to which they sometimes get snarky. When I'm feeling snarky I've responded with, "Start at the left index finger and trace a path to the right... you'll find it there, somewhere."

They often get bent about AC lines which I get but in the ED I'm just looking for a line and planning for an angio... if you want something else, start it yourself.

And then there's the issue of gauge... a couple of them like to bust my butt about sending a patient up with a 22... to which I respond with, "it was entirely adequate for their needs with me... if it's inadequate for you, start what you need."

Anyway, this whole line of questioning emphasizes why I consider verbal report to be an anachronism.

[Music in My Heart]

19 hours ago, MunoRN said:

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. 

Some comments are worth emphasizing... like this one.

[0.9%NormalSarah, BSN, RN]

On 1/20/2022 at 5:15 PM, Music in My Heart said:

I'm an ED nurse and I get so tired of them asking this question. Usually I respond with, "I don't know" to which they sometimes get snarky. When I'm feeling snarky I've responded with, "Start at the left index finger and trace a path to the right... you'll find it there, somewhere."

They often get bent about AC lines which I get but in the ED I'm just looking for a line and planning for an angio... if you want something else, start it yourself.

And then there's the issue of gauge... a couple of them like to bust my butt about sending a patient up with a 22... to which I respond with, "it was entirely adequate for their needs with me... if it's inadequate for you, start what you need."

Anyway, this whole line of questioning emphasizes why I consider verbal report to be an anachronism.

I’ll respectfully disagree with this one part about having a 22g, just because so many times when I’m getting a patient sick enough to come to the ICU, they tank on me as I’m receiving the patient and moving them over to their ICU bed. I need a larger bore PIV and preferably 2 of them, so I always just ask if they have tome to grab another one or one large enough before coming up that would be awesome. I do get that many patients are tough sticks and we gotta get what we can get sometimes, though! 

[Guest219794]

ER nurse perspective here:

It's silly and annoying, but I generally know where and what the IVs are, so I pass it on.  To the floor.  In the ER, when we pass this on to each other, it is generally as a joke, right up there with last bowel movement.  If, somehow this information is relevant, and not charted, we actually will pass it on- "She has a 20 in her AC, and the pump keeps occluding, so I am running ABX on gravity." Bowel movement would get passed on if the PT had an abdominal issue, possibly related to last BM.

If a patient has inadequate access, I'll address it, as that can't easily be found in a chart.  If you are getting a pt with a 22 in the boob and a 24 in the foot, clearly that was the best I could do.  I'll tell you that the intensivist has been informed, and I advocated for real access.

But, this outdated tradition of verbalizing IV information is part of a bigger problem:  Verbal report.  Verbal report developed in an ERA in which hand written information was kept on pieces of paper, and it might be difficult tor retrieve. I can 100% guarantee that by using Epic, I can get the general situation, and any details I find important, much faster by reading than you can pass it on by talking.  

And, more accurately.  Kids play a game called telephone- the whole point is to see how garbled information gets when passed on verbally.  Why on earth are we still doing this?  Why not pass the information on in a pantomime, or an interpretive dance?  If we aren't going to use the best tools at hand, we should at least make report more amusing.

Verbal report should very briefly cover the big picture, and anything relevant that is not easily found in the chart.

[Music in My Heart]

On 1/22/2022 at 3:09 AM, 0.9%NormalSarah said:

I’ll respectfully disagree with this one part about having a 22g, just because so many times when I’m getting a patient sick enough to come to the ICU, they tank on me as I’m receiving the patient and moving them over to their ICU bed. I need a larger bore PIV and preferably 2 of them, so I always just ask if they have tome to grab another one or one large enough before coming up that would be awesome. I do get that many patients are tough sticks and we gotta get what we can get sometimes, though! 

Short of volume resuscitation, a larger bore isn't necessary.

And I figure that if you/they want additional access, they/you are perfectly capable of attaining whatever is necessary for their purposes.

If a 22 was suitable for the patient condition and my orders, that's what they're likely to come up with.

[0.9%NormalSarah, BSN, RN]

55 minutes ago, Music in My Heart said:

Short of volume resuscitation, a larger bore isn't necessary.

And I figure that if you/they want additional access, they/you are perfectly capable of attaining whatever is necessary for their purposes.

If a 22 was suitable for the patient condition and my orders, that's what they're likely to come up with.

Peripheral vasopressor and inotrope therapy require a larger bore, according to most policies and medication admin guidelines. But yes your point about fluid resuscitation is fair. Hopefully some poor resident is preparing to get a central line in LOL. 

[Wuzzie]

3 hours ago, 0.9%NormalSarah said:

Peripheral vasopressor and inotrope therapy require a larger bore, according to most policies and medication admin guidelines.

Yes, but a 22 will suffice until the central line, that we begged for in the ED but didn't get, is placed. It isn't optimal but it's access. Also, I guarantee any ED nurse worth his/her salt wouldn't use a 22 unless that's all we could get. 

[Music in My Heart]

9 hours ago, 0.9%NormalSarah said:

Peripheral vasopressor and inotrope therapy require a larger bore...

I would love to entertain this as a topic unto itself but limited time and energy at the moment... other than to say that I would challenge this contention.

Perhaps another time.

[chare]

21 minutes ago, Music in My Heart said:

9 hours ago, 0.9%NormalSarah said:

Peripheral vasopressor and inotrope therapy require a larger bore [according to most policies and medication admin guidelines.]...

I would love to entertain this as a topic unto itself but limited time and energy at the moment... other than to say that I would challenge this contention.

[...]

Yes, I frequently hear this as well; however, I'm still waiting on someone to show me the "policies and medication guidelines" requiring this.  I have often run these medications through both 22 and 24 ga PIVs.  And, early in my career these were occasionally run via gravity.

[subee, MSN, CRNA]

15 hours ago, Music in My Heart said:

Short of volume resuscitation, a larger bore isn't necessary.

And I figure that if you/they want additional access, they/you are perfectly capable of attaining whatever is necessary for their purposes.

If a 22 was suitable for the patient condition and my orders, that's what they're likely to come up with.

IMHO, if a patient is sick enough to be admitted, they deserve more than a 22.  I understand how it happens but a 22 is a toy IV.

[0.9%NormalSarah, BSN, RN]

10 hours ago, Wuzzie said:

Yes, but a 22 will suffice until the central line, that we begged for in the ED but didn't get, is placed. It isn't optimal but it's access. Also, I guarantee any ED nurse worth his/her salt wouldn't use a 22 unless that's all we could get. 

Yes definitely, point taken. I agree that it’s not the nurse’s fault there’s not central access. I just made this comment originally to say that there were a couple scenarios where I’d ask if they had time to grab another IV that would be nice. I’m not calling out ED nurses, I have great respect for that specialty as I do all specialties. 

 

4 hours ago, chare said:

Yes, I frequently hear this as well; however, I'm still waiting on someone to show me the "policies and medication guidelines" requiring this.  I have often run these medications through both 22 and 24 ga PIVs.  And, early in my career these were occasionally run via gravity.

Yeah I get it, I did not work at that time and I understand an IV is an IV. It doesn’t change the fact that’s my hospital’s policy. Also I’ve read more just a couple of sources that say if you run them peripherally, it is highly recommended to use a large bore. That wasn’t actually the point of this conversation so I’m kicking myself for responding and moving this far off topic. 

 

5 hours ago, Music in My Heart said:

I would love to entertain this as a topic unto itself but limited time and energy at the moment... other than to say that I would challenge this contention.

Perhaps another time.

No problem. I wasn’t trying to start a little war here. Not really sure why my one comment saying if possible may I please ask you to grab another IV before coming up if you’re able is so contentious. I stated the reasons why I felt that way and I’m not off base at least with the information I’ve been taught and read myself. I’m not saying that still makes me entirely right, but I’m not trying to be snarky here.