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 was hospitalized as a child, in the days before the 3-stick rule. I vividly remember being stuck 7 times for a procedure. I wouldn't put anyone through that.
I haven't started IVs, but I've done blood draws. I work with the elderly, and I have much better luck with veins in the back of the hand. If I don't get blood on the second stick, I get someone else.
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!
Forgot to mention that I complained to the doctor once I woke up from surgery and they changed the hospital policy to only 3 tries!
At the hospital, I did my PCT in the rule was 2 sticks per person and you're out. That didn't mean some people were not trying to exact vengeance on the veins by sticking up to ten times before getting someone else...
Wow!! Eleven tries?? We would almost certainly be written up for that - especially on the floor I work on. We are only allowed to try twice in our facility then we have to call the nurse intensivist or IV team to start one.
I remember being in the hospital after my first child was born via c-section. I was so sick. One night after being there several already, my IV site infiltrated and they had to restart it. They stuck me sooo many times. I was tired and upset and just really wanted to go home. At one point I had 2 nurses digging on my left arm and then a nurse from the ER on my right arm, all at the same time! I have no idea how many times they stuck me before they finally got it, but I was crying because I was just so upset. So yeah... as a rule for myself, I will stick twice then I'm done! I know how it feels to be a pin cushion and I dont want my patients to ever feel that way.
I'll try twice on non-emergent adults, once on peds. If its a trauma, possible MI or CVA, then its a free for all with 2 nurses looking and sticking anywhere we can get a 16g or a 18g. Heroin overdoses--straight for the feet!!
They're very small. They disappear quite easily. Floors can't keep up with a thermometer or even a scale or a hoyer lift. They'd disappear.
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And they aren't miracles. They're great for teeny tiny babies where it's like threading a needle. For adults, not so much. With adults, it's not a problem of "finding" or "seeing" the vein. It's bouncing off leathery skin. It's crap veins that blow because you've dared go near them with a needle. It's rolling. It's scarred over veins. It's veins that won't thread.
rolling veins? makes me nervous... gosh, I hope I'm a good stick when the time comes
I had a patient once - great veins, but his skin was like leather because he worked outside his whole life (he was in his 60's). This was years ago when pts were admitted the night before surgery and went to the OR from the floor. I tried to start the IV in the am. Because his skin was so tough, by the time I got through the skin, the vein was in spasm. Tried twice. Hurt the guy like heck. Apologized and decided that was it. Informed OR that they would have to get it. They were NOT happy with me.
Came in the next night, had the same pt. He told me "don't worry about sticking me twice this morning - took the OR 7 tries before they got one!".
So my rule of thumb is 2 times, maybe 3 - then let someone else try. There is no shame in admitting that you can't get it.
Specializes in Community Health, Med/Surg, ICU Stepdown.
Bringing back this thread because I took 3 attempts to get an IV in today and felt horrible. I usually only try once or twice but today no one else who is trained with ultrasound was working and patient really needed an IV.
Luckily she had been my pt before and she likes me so she was very patient! She is rule out covid and I was swearing in a tiny isolation room wearing a plastic bag as a gown... yeah! first time I was right in top of the vein and the machine turned off! Had to withdraw needle, get other US machine. Second attempt was in vein but wouldn’t thread. Asked patient if it was OK to try again and she said “I believe in you!” And got it ?would never have tried again if there was anyone else! Thanks for listening to my unnecessary anxiety
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Not_A_Hat_Person, RN
2,900 Posts
I was hospitalized as a child, in the days before the 3-stick rule. I vividly remember being stuck 7 times for a procedure. I wouldn't put anyone through that.
I haven't started IVs, but I've done blood draws. I work with the elderly, and I have much better luck with veins in the back of the hand. If I don't get blood on the second stick, I get someone else.