How many times do you try to start an IV before calling in reinforcements?

[belgarion]

This has probably been covered before but I missed it so please bear with me. I got to work the other night and had a male pt. in his mid forties who was newly admitted earlier in the day. After report I started browsing through his chart on the computer and noticed an entry in the nurses notes that stated a 20ga. angiocath had been inserted in his wrist x11 attempts. Huh? Must be a double clutch on the number 1 key, right? I looked at the IV assesment tab and there it was again - 11 attempts, all by the same nurse. I might add there was no mention of dehydraton or edema anywhere in the dx. or notes.

I went to the pt.'s room and found a very unhappy camper. He was very vocal about being stuck so many times and his wife was almost in tears over the incident. I started checking him over and to me his veins didn't look all that bad, except for the bruises where he had been stuck. I went back to the nurses station and asked the charge nurse about this and she told me that that particular RN is known for multiple attempts. She said there have been a number of complaints about this very subject but since she is married to one of the county comissioners who oversee the hospital nothing is ever done. (God love small town politics!)

The nurse in question is an older RN who works prn as a charge nurse. She will not allow anyone else to start IVs when she is around. There was at least one other RN, a couple of LVNs, and a couple of EMTs in house at the time but she refused to ask for help. No one was aware of what was going on until it was over.

My question is, how many attempts is too many? How many attempts do you make before you call in someone else to try? My own personal rule of thumb is three strikes and I let someone else take a stab at it. (Sorry about that)

I might add the site infiltrated later in the night. I restarted it in the other forearm on one try. It was still working 48 hours later.

Any thoughts?

[HeartsOpenWide, RN]

I will try twice and then ask some one else to try. Not only does your confidence go out the window by the second failure but you are running out of veins. I work in OB and when I have a difficult one I call the E.R.; they can get anyone!

[nrsang97, BSN, RN]

I try 2 times. Occasionally 3. After that time for some fresh eyes to take a look. I have my go to people that can get an IV in a stone. I would never make 11 attempts. That is insane. I try to follow the three strikes and your out rule.

[ragingmomster, BSN, MSN, RN]

Mostly I will try twice before giving up but if will quit after one if the pt is really skittish. I have to have a relationship with my labor patients and stick+stick+stick+stick= don't touch me again.

[lpnstudentin2010, LPN]

I am currently just a patient. I will be starting LPN school in sept. I am a difficult stick due to deep veins, and I have had so many IV's that my veins are sclerosed (spelling?). I tell nurses who are starting IV's that I am a hard stick, so they usually spend about 5 minutes looking, and stick me 1 to 2 times before getting someone else. Mind you, I also go to a pediatric hospital

[NYRN05]

where i work...its about twice for policy...i will try a third time only if i am 99.9% sure, but i am a pretty good, and i usually go on the back of the forearm....there is always a nice fatty waiting hehehehheeeee. if all else fails then i call someone else.

[GM2RN]

I work in the ED and it depends. I'm pretty good with IVs so I don't have a lot of difficulty, but there have been occassions where I stopped at 1 because the pt just has no veins to speak of. There have been others where I have made 3 or 4 attempts depending on the circumstances.

I once had a pt come into the ED who was very obese with generalized pitting edema. He came in with acute CHF and DIB. I initially tried twice for a PIV, then called in the recruits. Three other nurses were unsuccessful, including the supervisor. Then the ED doc made one unsuccessful attempt at a central line, and finally the anestheologist on call came in and made 4 unsuccessful attempts at a central line, plus tried twice for a PIV before we finally got a PICC line in him. This guy REALLY needed some kind of IV access, so I had kept trying in between everyone else's failed attempts. So sometimes you just have to keep going.

[wooh, BSN, RN]

Grown ups, I'd try twice, and a third if I felt good about it because the first two were good "learning" experiences at why I missed them. But back when I did adults, I was one of the better sticks in the building, so I usually had it in those two unless the IV gods weren't with me that day.

Peds, I only stick if I feel good about it. Never more than twice (as there's usually someone better than me, I have a weird mental block when it comes to IVs since I started peds.) We've got IV team in house, so it's only at night or the occasional holiday that I'd "have" to start the IV. And even then, there are some that have much better success records than I do. Of course, our policy is 3x, then call the doc. Of course, if we'd bother trying a 3rd time, we already know that the doc will say it has to be started. We don't try a first time if there's any chance they don't need it. If it's just for hydration, we'll often drop a feeding tube instead and give pedialyte if they aren't vomiting. For antibiotics, we switch to PO as soon as possible. And we try really hard to get a PICC in anybody that will be there for a while needing and IV.

Eleven times? THAT is crazy. If you haven't realized that the IV gods are not smiling upon you at some point before #11, then you might need admission to a psych hospital.

[bridezillatobe]

When I had septoplasty it took them 17 tries! The anesthesiologist finally had to put me out and I woke up with one in my arm and on in my foot! Had more pain from the IV tries than the surgery!

[GM2RN]

Yeah, I forgot to mention peds but I have to agree with the previous post when it comes to doing kids.

[Spidey's mom, ADN, BSN, RN]

Written policy says two attempts where I work - have you checked the policy at your hospital? That might be your out with the nurse who tried 11 times and won't ask for help. No matter who she is married to . . . .

steph

[roser13, ASN, RN]

Facility policy: 2 tries, you're out. Most of us will only try once, then get help or at least a 2nd opinion.