Home Health IVs w/new grad nurse

  1. I'm a middle-aged new grad, looking at job listings, and my immediate thought on a 'Home Infusion RN' listing is that I might not mind doing it, but given one particular experience in clinicals, where I couldn't find ANYTHING on this guy's arm or hand, what do you do in that situation? You're by yourself at their house. To save a bunch of you from responding 'well, you just gut it out and get it done somehow' ... yeah, I understand that, but again, there are some very difficult patients to start or change IV's on. Just wondering if anyone has any special advice there.
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    About djh123, BSN, RN

    Joined: Dec '09; Posts: 1,012; Likes: 2,726


  3. by   Sun0408
    I was under the impression these pts had PICC lines or porta caths ??
  4. by   lovingtheunloved
    99.999% of the patients we infuse in the home have PICCs or ports or the occasional central line. It's extremely rare to have a peripheral line in the home. My agency at least, I have no idea what others do.
  5. by   djh123
    Thanks for the replies!
  6. by   KelRN215
    I have never seen a peripheral line in the home and my agency will not take a patient who needs infusions without permanent access. The vast majority of my patients have ports, double lumen broviacs or PICC lines. Ports and CVLs more so in the oncology population and any child who goes home on IV antibiotics has a PICC line.
  7. by   paradiseboundRN
    I've been in home care for 11 years and I haven't put in a peripheral IV in 11 years.
  8. by   threebrats46
    I get many PIV patients,and one particular one was a very hard stick that even her MD was surprised we were able to get anything in.
    If i can't get it in after 2-3 tries,they send another RN to try. I also brought a vein light I use and sometimes it helps. The majority of the patient's have a PICC,Hickman or port.I think Port accessing is worse for me then placing PIV.
  9. by   lovingtheunloved
    Why is port access worse than a PIV? You can't miss.
  10. by   eatmysoxRN
    I work in a hospital setting but I have had outpatients come in for IV antibiotic infusions and go home with PIVs. I'm sure in a HH setting you'd have protocols if you needed peripheral access and couldn't obtain it.
  11. by   KelRN215
    Quote from lovingtheunloved
    Why is port access worse than a PIV? You can't miss.
    You most definitely CAN miss with accessing a port.
  12. by   lovingtheunloved
    Well of course you CAN miss, it's just pretty unlikely. I just don't get how that's harder than a PIV?
  13. by   KountryPrincess
    Depends on the pt. If it is a pediatric pt with a pediport and an emaciated sunken contracted upper torso and the thing rolls, yeah.....you can miss. Really though, I would say in gerenal, on 99% of pts, portacath access is a snap compared to peripheral IV access. BTW I really admire you guys with good peripherial IV starting expertise. In my 15 year career I have never had to start an IV & it really intimidates me. I worked inpatient Onc for the first 5 years of my career where the pts had central lines mostly and if they didn't, we had an IV therapy team. Now in HH for the past 10 years, we don't do home IV therapy unless the pt has a central line.
  14. by   KelRN215
    It depends on the patient. I have a patient who is severely developmentally delayed and blind... his parents have to lay on top of him to get him into position to access his port and he still never stops moving. And his port is deep. It's easy to miss on him. Some teenage girls if the ports are underneath their left breast, I'd much rather do a peripheral stick. I do have one patient who has a port-a-cath who I do peripheral sticks on for labs... he doesn't like being accessed when he doesn't have to be and his port is super positional. He's a wicked easy stick so I don't mind. For IV therapy (as opposed to labs) in the home, we only take patients with central lines.