Giving Report and IV Access

Nurses General Nursing

Updated:   Published

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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??

14 hours ago, 0.9%NormalSarah said:

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. 

Why?

Why are folks focused on the bore of the IV?

The integrity of the vein itself is absolutely critical for vasopressors, vessicants, etc.  But why does anybody think that the guage IV is related to what drugs go through it?
I am pretty good at IVs.  Let's say I put an 18 or 20 gauge into a vein, and it takes up most of the lumen of the vein.  Now, I have minimal blood flowing around that catheter I expertly threaded into a narrow vein.  Whatever I put through that catheter enters the vein with limited dilution.  Compare that to the exact same vein with a smaller catheter.  The potential irritant is much more diluted because of the increased blood flow.

A 24 g catheter can handle 1,000 ml/hr.  

Blood can be transfused through a 24 gauge IV, as evidenced by all of the neonatal/pediatric transfusions that run through 24s.
 

I am an ER nurse.  I like 18s.  I use them a lot.  I am comfortable putting difficult IVs in, and get them sometimes even when the doc can't get one with an ultrasound.  But- small IVs have their place, and can be lifesavers.  I think the IV size thing is a one of those persistent nursing myths.

 

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Specializes in ICU.
2 hours ago, hherrn said:

Why?

Why are folks focused on the bore of the IV?

The integrity of the vein itself is absolutely critical for vasopressors, vessicants, etc.  But why does anybody think that the guage IV is related to what drugs go through it?
I am pretty good at IVs.  Let's say I put an 18 or 20 gauge into a vein, and it takes up most of the lumen of the vein.  Now, I have minimal blood flowing around that catheter I expertly threaded into a narrow vein.  Whatever I put through that catheter enters the vein with limited dilution.  Compare that to the exact same vein with a smaller catheter.  The potential irritant is much more diluted because of the increased blood flow.

 

 

Good discussion. I actually mentioned above I've taken this thread off-topic, so I decided to open a new discussion, and here is the link! 

As I state in the new topic, thanks to you who have questioned my statements as I've been able to get out of the forum and do a little research, and I hope you can join me over on the new thread for more discussion. @chare @Wuzzie @Music in My Heart 

 

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Specializes in Critical Care/Vascular Access.

As an IV therapy/PICC/ICU nurse, I'm surprised that any RN doesn't see the importance in reporting off the size, location, and functionality of your access. It's silly to expect the oncoming nurse to have to look up your charting. If that's the case, then why give report at all? Why don't they just look it all up instead and you just peace out and go home as soon as the next shift shows up? Come on now.

You should be able to competently take care of your patient as soon as you leave report, without having to peruse through their chart. That's essentially the point of report. Any nurse that's ever worked on a busy floor knows you don't always have time to sit and read through the charts before things start to get busy. Often an important part of being busy is knowing what their access is, where it is, and what you can run through it.

As IV therapy, we get PIV requests all the time around change of shift because the offgoing/oncoming nurse finds bad IVs. Also, we find uncharted IVs frequently, not to mention unnaccessed chest ports no one knew about (including the doctor, after many failed sticks), or midlines charted as PICC lines. The list goes on........point is, knowing your lines, charting them accurately, and reporting them matters.

Honestly, it just seems like bad excuses for lazy nursing when you try to defend being clueless about your patient's access. Not knowing implies you also probably don't even know if it's functioning or not.

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9 hours ago, Mr. Murse said:

Honestly, it just seems like bad excuses for lazy nursing when you try to defend being clueless about your patient's access.

That's a bit on the nose. How about it's because ED  nurses are working extrememly short and being pulled in a million different directions often with 8 patients or more. Not only that it is not uncommon for another an ED nurse to call report on another nurse's patient because they are involved in something more critical.  Nobody said it was okay not to know whether a line is functional or that it's okay to send up an infiltrated IV but sometimes I can't remember if the 20th line I started in a shift is in the right or the left AC at the time of report. 

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Specializes in Critical Care/Vascular Access.
7 minutes ago, Wuzzie said:

That's a bit on the nose. How about it's because ED  nurses are working extrememly short and being pulled in a million different directions often with 8 patients or more. Not only that it is not uncommon for another an ED nurse to call report on another nurse's patient because they are involved in something more critical.  Nobody said it was okay not to know whether a line is functional or that it's okay to send up an infiltrated IV but sometimes I can't remember if the 20th line I started in a shift is in the right or the left AC at the time of report. 

You're talking about ED report to the floors or unit, not inter-shift report on the unit, where I feel like it is a useful part of report that's not very hard to keep up with. Coming from the ED it is more excusable, but I still feel like the ED nurse should at least make an effort to report the access if possible. It's more acceptable when the nurse handing off says, "sorry, I got busy and don't remember where it is but I know they have a good access" than just acting like it doesn't matter if they send up some janky 24g in the patient's pinky finger with the catheter half hanging out.

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Specializes in Psych, Addictions, SOL (Student of Life).
20 minutes ago, Wuzzie said:

That's a bit on the nose. How about it's because ED  nurses are working extrememly short and being pulled in a million different directions often with 8 patients or more. Not only that it is not uncommon for another an ED nurse to call report on another nurse's patient because they are involved in something more critical.  Nobody said it was okay not to know whether a line is functional or that it's okay to send up an infiltrated IV but sometimes I can't remember if the 20th line I started in a shift is in the right or the left AC at the time of report. 

I don't think the original comment was about RE to floor report but rather a shift change report where the off-going nurse has had 8-12 hours with that patient and should know where the IV access is and be able to pass that on in report. That being said I personally don't mind looking things up in the chart if I'm not slammed. We don't do IV's where I am but when I moonlight there's nothing worse than going in to hang an IV right after report only to find it infiltrated or out all together.

BTW I have great admiration for ED Nurses. All nurses work crazy hard but you all rock!

Hppy

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3 minutes ago, Mr. Murse said:

It's more acceptable when the nurse handing off says, "sorry, I got busy and don't remember where it is but I know they have a good access" than just acting like it doesn't matter if they send up some janky 24g in the patient's pinky finger with the catheter half hanging out.

I guess I have more faith in my colleagues as I have never worked with anyone who would leave out important details such as poor access like you described.  I've been doing this for 36 years so I've worked with a lot of nurses. It's usually the first thing mentioned. 

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Specializes in Psych, Addictions, SOL (Student of Life).
2 minutes ago, Wuzzie said:

I guess I have more faith in my colleagues as I have never worked with anyone who would leave out important details such as poor access like you described.  I've been doing this for 36 years so I've worked with a lot of nurses. It's usually the first thing mentioned. 

I hear you! I once received a great report in a nursing home where the off going nurse We had a difficult time getting access and got one in the bottom of the left foot and there were Stat atbs. An infusion service has been called and a midline ordered.

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23 hours ago, Mr. Murse said:

As an IV therapy/PICC/ICU nurse, I'm surprised that any RN doesn't see the importance in reporting off the size, location, and functionality of your access. It's silly to expect the oncoming nurse to have to look up your charting. If that's the case, then why give report at all? Why don't they just look it all up instead and you just peace out and go home as soon as the next shift shows up? Come on now.

You should be able to competently take care of your patient as soon as you leave report, without having to peruse through their chart. That's essentially the point of report. Any nurse that's ever worked on a busy floor knows you don't always have time to sit and read through the charts before things start to get busy. Often an important part of being busy is knowing what their access is, where it is, and what you can run through it.

As IV therapy, we get PIV requests all the time around change of shift because the offgoing/oncoming nurse finds bad IVs. Also, we find uncharted IVs frequently, not to mention unnaccessed chest ports no one knew about (including the doctor, after many failed sticks), or midlines charted as PICC lines. The list goes on........point is, knowing your lines, charting them accurately, and reporting them matters.

Honestly, it just seems like bad excuses for lazy nursing when you try to defend being clueless about your patient's access. Not knowing implies you also probably don't even know if it's functioning or not.

Silly and lazy.  Interesting perspective.
I would say it is silly to think a verbal report is more accurate than charted documentation, and lazy to expect another nurse to spoon feed it to you.  But, tomato tomato.  (That works better when it is said with two different pronunciations.)

But, I guess a lot has to do with your EMR system.  When I click on a chart, I can see the IV documentation immediately.  I have found many nurses don't seem to be comfortable with quickly accessing critical information, and rely on the same hand written "brain" their preceptor's preceptor's preceptor used before EMRs.

And, I agree there should be more education out there about IVs.  

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Specializes in Critical Care/Vascular Access.
8 hours ago, hherrn said:

I would say it is silly to think a verbal report is more accurate than charted documentation, and lazy to expect another nurse to spoon feed it to you. 

I'm wondering, do you believe nurses should be doing shift change reports at all then? Why not peruse through the charting instead?

As for charting, I can't tell you how many copy-pasted and erroneous IV charting we see as IV therapy. Aside from the fact that I shouldn't have to go look in charting at the beginning of my shift to fill in what the off-going nurse failed to tell me/didn't know about their patient, the charting is wrong an alarming percentage of the time.

It's just much easier to know your IV access and report it off.

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Specializes in Psych, Addictions, SOL (Student of Life).

Some of the totally passive aggressive comments here from nurses who don't want to be bothered giving an accurate report is an indication of bullying (and I hate that term) and a total lack of comradery among today's nurses.

Like Isaid earlier I don't necessarily mind looking things up in the chart, but it's nice to get an accurate report when you start your shift. I actually tailor my report for the on-coming nurse and report off on 16+ patients.

Hppy 

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Specializes in CRNA, Finally retired.

Reporting all by itself, is an art form and deserves a couple of hours as a topic in nursing school.

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