Giving Report and IV Access

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MunoRN, RN

Specializes in Critical Care. Has 10 years experience. 8,058 Posts

6 hours ago, Mr. Murse said:

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.

The purpose of report is not to recite a list of data-points with no thought given to the relevance or significance of those data-points.  It's about pulling out the significant data and how that relates to the bigger "story" of the patient.

If the patient's potassium level is 2.9 or 6.9, that's significant and worthy of report, whether it's 4.2 or 4.3 is not.

If the patient has a single PIV and it's a 24 in the big toe, and it doesn't work anyway, that's significant, whether their 2 PIVs is a 20 in the left forearm and an 18 in the right AC or whether it's the other way around is not significant.  If this isn't something the nurse needs to be specifically told because they wouldn't be able to quickly figure that out on their own then that's a problem, but not a problem with report.

2 hours ago, MunoRN said:

is not significant

this exactly.  Next time someone wants IV details in report I'll say "I don't recall, but they have one that works"

Guest219794

Guest219794

2,453 Posts

14 hours ago, Mr. Murse said:

I'm wondering, do you believe nurses should be doing shift change reports at all then?

Absolutely.  There are nuances  that are not charted that help the oncoming nurse understand the big picture.  Family involvement, pt pet peeves, that sort of thing.   And, having the off going nurse provide an overview gives context to the details that can be easily seen in the chart.

The night nurse telling me the patient had no relief from MS, 4 mg, so she gave dilaudid 1 mg, which tanked his pressure, and she then gave 3 liters NS was helpful.  She told me he was still a bit soft in the low 100's, but that was normal for him.
That narrative was a good use of report time.  The exact pressure, location of the IV, etc are easily found details I don't need verbalized.  But- tell me something that helps me understand the big picture, and I find it helpful.

14 hours ago, Mr. Murse said:

Why not peruse through the charting instead?

I agree- why not?  I do.  Every single time.  I skim the H&P in under 2 minutes.

If it's relevant, I might even look at the labs.  This does not take me time, it saves me time.

Mr. Murse

Mr. Murse

Specializes in Critical Care/Vascular Access. Has 11 years experience. 403 Posts

8 hours ago, MunoRN said:

The purpose of report is not to recite a list of data-points with no thought given to the relevance or significance of those data-points.  It's about pulling out the significant data and how that relates to the bigger "story" of the patient.

I guess I just don't see the access as an inane data point, and I can't agree with the arguments suggesting as such.

Furthermore, I really don't understand why remembering where your IVs are (especially in the ICU) and spending 15 seconds in report is more cumbersome and annoying than having to either look it up or walk in the room to find out.

Clearly, this is a divided topic. Many nurses (myself included) find this information helpful, especially if you hit the ground running and CT calls you right after report to verify Mr. So-and-so has a 20g above the forearm for contrast (or insert any large number of scenarios where knowing your access without having to look it up matters).

So at the very least, out of respect for the many of us who do find it useful, just spend a few seconds to placate our OCD please.

Edited by Mr. Murse

Nurse E

Nurse E

Specializes in School nurse, Tele, Med surg, Neuro. Has 12 years experience. 1 Post

The only reason why I like to know the location of the IV is because in case of an emergency I want to know where to quickly access her IV. but I don't make a fuss or a big deal if they don't know or don't remember, nor do I ask in every report/patient. Only when the patient is fragile.. And depending on the nurse, as we all know some people that chart during report without laying eye on the patient.  I have also had bad experiences with some people that never flush the line and then when IV meds are due on my shift for that patient, they're line is clogged and IV need to be changed, ( which I enjoy doing, but it's nice to be prepared) or IV is wayy outdated, then they turn out to be a very hard stick with no veins, then the meds are late, then everyone's meds are late, Then all the bells are going off, then every patient wants the nurse, then families start calling, then all hell breaks loose! LOL

Edited by Nurse E

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Community, Nurse Manager. Has 6 years experience. 2,067 Posts

On 1/19/2022 at 12:29 AM, MunoRN said:

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".

You’re not really this mean, are you? 

AnxietyMaven

AnxietyMaven, BSN, RN

Specializes in ER. Has 2 years experience. 30 Posts

On 1/22/2022 at 5:09 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! 

In ER I insert what I can... Most of the time it's an 18 in the AC if I can get it. If it's an ICU patient it's 2 -18's (obviously again... If I can get it). This is important to keep my patient alive until I can transfer to ICU while pressure bagging fluids to bring up their pressure... That said, if I'm giving report and you ask for another IV?  ?… It's not going to happen when I have 5 other patients. It's not me being rude, I just I don't have the time. I don't think any of us "have the time" so I'm not being snarky and starting anything here by saying that. I don't see not placing an additional one as a lack of professional courtesy. 

On the topic, I usually say what/where/gauge PIV a patient has so that the nurse taking report doesn't have to ask, and interrupt me giving report ?.

Music in My Heart

Specializes in being a Credible Source. Has 12 years experience. 2 Articles; 4,101 Posts

On 1/24/2022 at 3:54 PM, 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.

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.

 

Vessel integrity and hemodilution... that's what it's about.

People are, I think, confused about the WHY of the bore size... a myth persists, even, that one cannot give blood through a 24 or even a 22... despite all the transfusions that our NICU colleagues are running on those teeny-tinies...

Bore size matters ONLY in terms of volume resuscitation. (That said, there is some evidence that suggests that bore size can affect the dwell time of the catheter but that's beyond the scope of this conversation.)

In the ED, I commonly find that a 22 is sufficient for a large portion of my adult patients... and all of my pediatric patientes... this is particularly true if I have access to a high-flow device like BD's Diffusics line through which I can run a CT angio at 5 mL/sec.

Understand that this is not about large-bore discomfort with me... just 2 days ago, I had an acute GIB on the floor... hypotensive and symptomatic. I put a 14 in one AC and a 16 in the other... because that's what the situation called for and what I was able to achieve with 1-stick confidence.

Guest219794

Guest219794

2,453 Posts

On 1/27/2022 at 1:31 PM, Nurse E said:

The only reason why I like to know the location of the IV is because in case of an emergency I want to know where to quickly access her IV. but I don't make a fuss or a big deal if they don't know or don't remember, nor do I ask in every report/patient. Only when the patient is fragile.. And depending on the nurse, as we all know some people that chart during report without laying eye on the patient.  I have also had bad experiences with some people that never flush the line and then when IV meds are due on my shift for that patient, they're line is clogged and IV need to be changed, ( which I enjoy doing, but it's nice to be prepared) or IV is wayy outdated, then they turn out to be a very hard stick with no veins, then the meds are late, then everyone's meds are late, Then all the bells are going off, then every patient wants the nurse, then families start calling, then all hell breaks loose! LOL

The best way to be ready for an emergency in regards to an IV is not to have somebody verbalize to you their memory of the IV.  Even if they checked it recently, and report it accurately, there is nothing saying it is working now.
If you want to be ready, flush and cap the IV yourself.

 

Music in My Heart

Specializes in being a Credible Source. Has 12 years experience. 2 Articles; 4,101 Posts

1 hour ago, hherrn said:

The best way to be ready for an emergency in regards to an IV is not to have somebody verbalize to you their memory of the IV.  Even if they checked it recently, and report it accurately, there is nothing saying it is working now.
If you want to be ready, flush and cap the IV yourself.

 

Even in the ED and the ICU, regardless of what anybody tells me, the first thing I do when I assume care is a quick flyby to introduce myself, do a quick ABCD assessment, AND flush the line(s)...

Regardless of who says what, access is MY responsibility on MY patient... from the beginning of my watch.

The notion of needing to specify for another nurse WHERE the IV is located is simply ridiculous... and in no way relieves one of the responsibilty for the line on their patient.

Nurse Pompom

95 Posts

We keep track of IV locations and dates, IV gauge.. If there is a problem, as in, if it is infected, no blood returns, etc...we know which one, who checked it last.. if you have to give blood, you know what you are working with..while it can seem tedious, it's part of the report and I don't mind passing on the information. 

Furthermore, medicare will not pay for the entire hospital stay if the hospital is liable (ie: pt who didn't have a uti before foley now has a foley). Here is the list https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions

While there are more important things to pass on, this doesn't mean it shouldn't be part of the report. Because where does it stop? "Pt has a broken arm, figure out which one yourself"? 

In my opinion, nurses should have standards, and giving a good report is part of that. Now don't get me wrong, I know some nurses are difficult at report, but don't become difficult too for the opposite reasons. 

Edited by Nurse Pompom

akulahawkRN, ADN, RN, EMT-P

Specializes in Emergency Department. Has 7 years experience. 3,488 Posts

17 hours ago, Music in My Heart said:

Bore size matters ONLY in terms of volume resuscitation. (That said, there is some evidence that suggests that bore size can affect the dwell time of the catheter but that's beyond the scope of this conversation.)

In the ED, I commonly find that a 22 is sufficient for a large portion of my adult patients... and all of my pediatric patientes... this is particularly true if I have access to a high-flow device like BD's Diffusics line through which I can run a CT angio at 5 mL/sec.

I'm also an ED RN. Pretty much this. In my ED, we run primarily the BD Diffusics catheters. Even the 22g is remarkably capable for volume resus, though nowhere near what a 16g or 14g is. My usual go-to's are 20g and 22g BD Diffusics. If I need VOLUME, then I'll choose a larger bore line. If the patient is a difficult stick, I'll grab the ultrasound. 

Also as an ED RN, unless the line is in a (relatively) unusual location, a central line/port, or there is an issue (like it's positional) with the line, all I really want to know is if there is IV access, and if more than one line, how many. I can quickly figure out the rest.