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?

[BrnEyedGirl, BSN, MSN, RN, APRN]

I work ER,.our policy is to try twice then get someone else. If it's really a tuff stick we use US at bedside.

[GoECU]

I work in prison and I would not even try 11 times! One or two for me!

[Dixiecup]

I'm surprised the pt let her continue. He has the right to say "go get someone else!" and should have.

[Blueorchid, ASN, RN]

Eleven times?? Wow...

I've seen 2-3 attempts most places. If I miss the first time I really look before I go a second. I'm still learning so there's a toss up between saving the veins if they have nothing and wanting to get that stick because I -know- I could hit it. If I've ended up fishing around for a bit (they have rolling veins or maybe something disappeared once I stuck it) I might ask if I can go again too. Usually that ends up keeping people happy- yay PR! However in an emergent situation (provided you're good with IVs) I agree that you need to keep trying.

The way I see it though, if there's someone on the floor who can do things better than you (and they're available) let them do it for the good of the patient. Oh and ask questions when things are toned down! At least...from a student's point of view

[rn4ever?]

I try twice then call for help. But when I was a patient, I realized that each one should only try once.....when I was a patient, three RNs tried thrice and then finally the Anesthesiologist! Imagine ten sticks!

[clemmm78, RN]

I don't care who she is married to. There must be something written down about how many are allowed. That is not best practice and if I was the patient, I would have turned into a raving patient (or if I was the wife of the patient, I would have been livid). I would even have reported her. No excuse to try 11 times yourself. I can understand it taking that many times with other people, but no way, no how that many times with the same nurse all at once.

[Chico David, BSN, RN]

Most people have come up with pretty similar answers here: in the range of 2-3 tries. Our hospital has a written policy of 3 as a max. Which brings me to the point related to your current situation: If no one in management has the guts to deal with this individual nurse on the issue, it is way past time for someone to write a policy for everyone that will rein her in. It is unconscionable to allow a patient to be stuck that many times. Go to your supervisor and up through the chain of command as needed and convince them to institute a hospital wide policy.

[earthcrosser]

In the NICU I work at, we can try twice if appropriate. If I got in report that it took transport four sticks to get the latest PIV in, you better believe I'm not gonna attempt it myself. We've had issues with people sticking the babies way too many times and blowing tons of veins that may have possibly been gotten by someone with better skills. We've got free charges and transport team to assist with new PIV starts if needed. They are really great for that sort of thing.

[resumecpr]

Our hospital policy states two attempts by 1 RN, then 1 attempt by a second RN. Then......try and have the physician throw in a CVC.

We have a few ED docs that will use an ultrasound to guide peripheral line insertion. Just the other day we had a patient come to the unit with a 20g in his right abdomen, and an 18g in his right calf.

Personally, I will try twice, then ask the patient if they want to be stuck again. Most of them are agreeable as they are sick enough to warrant this line.

[Dalzac, LPN, LVN, RN]

Three strikes and I am outta there

[BuckyBadgerRN, ASN, RN]

As a nurse, I'll try twice. As a patient, I'll let you try twice. I feel so bad for the patient who didn't exercise his right to say "ENOUGH! Please find someone else to try"

[klone, MSN, RN]

The policy wherever I have worked is two attempts, then you must ask another nurse. In a pinch, I've attempted x3, but never more than that.