guidelines for passing difficult starts to IV team

[tambora]

We are in the process of having all nurses in our health authority gradually start to do the "less difficult" IV starts and restarts. For those of you with IV teams, where the nurses on the units do most of the starts, just passing the really tough ones, do you have written guidelines that they use to determine when to defer to the team or is it just a matter of their judgement. We are trying to avoid the "six pokes before the IV team gets called" by creating guidelines. Any help would be appretiated.

Thank you,

[iluvivt, BSN, RN]

Sure I can help you this is an easy one, I agree with you that you do not ant to be the one to approach a patient and and or family after they have had multiple unsuccessful venipuntures. The patient and or family is often distrustful and upset not to mention that many veins have been punctured and are unavailable for use at that time.

Here is the list I would make when an IV nurse should be called.

1. Perform no more that 2 attempts (this is total not per person of course).

2. Patient with a hx of IVDA

3. Patient with a hx of difficult venipuncture and/or frequent hospitalizations that have limited available suitable veins to cannulate.

4. Patients with only one available limb to use. (these are usually dialysis patients and are difficult anyway)

5. Patients that will be receiving chemotherapy or any medication that could cause extravasation (ie Dopamine, levophed,3&5 percent sodium chloride). There are amny more drugs that should be on this list.

6. Patient that after being assessed by more than one staff nurse has no veins that the nurses believe that they cannulate or locate. (remember you can not see it or feel it generally speaking do not poke it.

I would also include in this list that the nurse is to notify the IV team if patient has an order or diagnosis or hx of difficult venipuncture that will require something more than a PIV. That way you can get your PICCs or CVCs in early.

PS if I think of more I will add to the list. Some of the categories need to be a bit boad to cover many possible scenarios. Also I would never force a nurse to perform a venipuncture if upon assessment they believe there chances are slim to none. Nurses know there skill level and I just believe them. I do not make them jump through hoops to get to me. Believe me you get to know who is good at it and who is not.

[sbenelli]

hy, I like it, can you help me, I am a PICC nurse and we are considering a iv team, i will really apreacitedd any help