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.
I asked my mom if an Rn could do an IV to a patient...she's an RN and she works at O.R. and she told me that RN's are NOT entitled to give IV's to patients!! and she said it's supposed to be the doctor who will do it. not the nurse.
so i'm confuse? i'm an upcoming nursing student this fall, and u guys have been talking about giving shots and IV so i dunno if she's right?
are Nurses not entitled to giving IV???
Newbienurse,
Perhaps it is the policy of the institution that your Mom works for which dictates her information/practice... However, in most Hospitals and other health care facilities, RN's and LPN's/LVN's who are IV certified not only place IV catheters but give medications into those catheters. Here in the USA, a RN or IV certified LPN can place a line, or IV catheter in a patient easier and with greater proficiency than 99.9% of your MD's.
First, that's cool. But second, unless the person is REALLY skinny, how can you tell when it infiltrates (if the patient can't report pain?) Seems like abdominal fat would hide swelling at the site. But third, cool!
I asked my mom if an Rn could do an IV to a patient...she's an RN and she works at O.R. and she told me that RN's are NOT entitled to give IV's to patients!! and she said it's supposed to be the doctor who will do it. not the nurse.
so i'm confuse? i'm an upcoming nursing student this fall, and u guys have been talking about giving shots and IV so i dunno if she's right?
are Nurses not entitled to giving IV???
In OR, if not started before they go back, it's usually the anesthesia provider that will start the IV.
While I think it's important to listen to patients when they tell you that they are a hard stick or have "rolling veins," I always take this information with a grain of salt. Often I find that the labels "hard stick" and "rolling veins" are the result of someone with less experience or just not taking the time to find an appropriate vein. While some of these patients are truly hard sticks, I'm surprised at how many times it's just a matter of patience and experience. I also find it a bit amusing when young and otherwise healthy individuals tell me that they have rolling veins only to find that is not actually the case.
"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."
That is truly scary!!
First of all, one MUST think, why are there palpable/visable veins in someones Abdomen??? Normally, they aren't there, just like there usually aren't vessels one should be cannulating in the breast area. So... Is there a thrombus somewhere causing these vessels to engorged?? And, should we be cannulating them? My answer is a resonding NO. Also, cannulating LE is not appropriate in many cases. Thrombus rates soar so one should make sure that there are stipulation in place prior to undertaking this task.
#1. MD's order
#2. Pt must be non-ambulatory
#3. Policy and Procedure for that facility needs to be in place regarding this practice.
We have a general rule that twice is typically enough to get it if you're going to get it at all. I always look at both arms for my best spot, and then poke away! If I don't get it, we have at LEAST a few others on our floor that are excellent. We also have "rapid response" that will come up if nobody is able to get the person. We are blessed with a few supervisors that are also very good at sticks for the hard patients.
That all being said, ELEVEN times is enough for me to confront the person and to write an incident report. The patient was NOT happy, and I would also have said, "YOU HAVE THE RIGHT TO REFUSE ANYTHING YOU WISH." to the patient and his wife. This would, honestly, be one of the easiest situations for me to handle because it involves you saying in your head, "You're totally right." but saying, "I understand because I wouldn't want to be poked that many times either... I don't poke that many times myself, but everybody is different. If you have problems like that in the future, PLEASE insist on another person coming in... she/he might have had a rough day, and everybody's IV skills are NOT the same."
"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."
That is truly scary!!
First of all, one MUST think, why are there palpable/visable veins in someones Abdomen??? Normally, they aren't there, just like there usually aren't vessels one should be cannulating in the breast area. So... Is there a thrombus somewhere causing these vessels to engorged?? And, should we be cannulating them? My answer is a resonding NO. Also, cannulating LE is not appropriate in many cases. Thrombus rates soar so one should make sure that there are stipulation in place prior to undertaking this task.
#1. MD's order
#2. Pt must be non-ambulatory
#3. Policy and Procedure for that facility needs to be in place regarding this practice.
i thought it was implied that a Doc placed those.....
Specializes in Spinal Cord injuries, Emergency+EMS.
2 or 3 times then get someone else to have a look or leave it for an hour or two .... there is no excuse for frantic stabbing ,alternatively if the patient is sick enough they need an IO , EJIV or central line inserted by an appropriately trained operator not being turned into a pin cushion...
Just got in from work and something may get done. The pt's. doctor was in this morning and he was definitely NOT happy. I have a feeling there will be some people with parts of their anatomy missing before lunch.
There is no hard and fast policy here regarding how many times you can try. I guess it's because of our small size and the fact that during a period of low census there may only be a couple of nurses on duty. The general "suggestion" is three max which is my own personal limit. I have a feeling a policy may be coming out very soon.
I'm not the greatest in the world at starting IVs so I only make three tries if I see something in the first two that makes me think a third try will work. I have no problem waking away with no tries if I don't like what I see.
Two. It isn't fair for one person to keep sticking them. I always grab someone else if I can't get it in within those two tries.
And my hospital has a policy where one person can only stick the patient twice, then grab someone else...if they cannot start an IV in two sticks they must call the MD.
I don't think anyone actually follows that rule, we just grab another nurse again...imagine how upset the MD would be if the nurses couldn't start an IV on a patient...
IVRUS, BSN, RN
1,049 Posts
Newbienurse,
Perhaps it is the policy of the institution that your Mom works for which dictates her information/practice... However, in most Hospitals and other health care facilities, RN's and LPN's/LVN's who are IV certified not only place IV catheters but give medications into those catheters. Here in the USA, a RN or IV certified LPN can place a line, or IV catheter in a patient easier and with greater proficiency than 99.9% of your MD's.
Strange place your Mom works at!!