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Discussion

IO and US guided IV insertion at a Level One Academic Teaching facility.

Hi Everyone,

Just wondering what other facilities are doing nationwide. I work for a very busy Level 1 Academic teaching facility. I was wondering what other facilities are doing with difficult access patients. Now I am the first person who is not afraid of difficult sticks and can put an IV in nearly anyone, however, I have worked in smaller institutions where IO access was taught to nursing and pushed for nursing to use in septic and coding patients. Are there other academic teaching facilities that do this? I understand the need is not as great because as with any teaching facility, you have plenty of hands and plenty of physicians who are looking to practice EJ's or central line access. So I'm wondering what are all your thoughts, and practice.

With the new ENR from the ENA regarding US guided, are a lot of other hospitals providing training to staff ED nurses to do this? How is it coming along? I can think of several instances where this training could help out and wonder what the implications are and how we can get the ball rolling.

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    In the ED I work in, nurses can put in EJ's, do US guided IV's, and IO's, if necessary.

    EJ's are done pretty regularly. I do a couple a week on average.

    I've only seen the US guided IV done a couple of times and both times were done by a former cath lab/surgery nurse who's had extensive experience with them.

    And as far as IO's, I've yet to see one done in the ED. I've only seen them on pts that coded in the field and were started by EMS.

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    In our hospital (Belgium - Major Teaching Facility/Trauma Center) we can place EJ's as a nurse, in theory we could do US guided IV's but we don't ever bother. And placing IO's is reserved for nurses that have a title in "emergency and intensive care nursing care". Generally we'll try EJ over IO first except children that are coding/crashing here we go to IO right away.

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    In our hospital ICU & ER nurses have been placing IOs regularly since around 2003-2004. If you need access now and can't get the IV in a stick or two we go to IO, unless it is totaly not critical and they can wait for the PICC placement. We don't need an order to place IO. All ER & ICU RNs are trained to place IOs and this has been the case for a long time. We also have Site Right ultrasounds available and have (or some other US) for the last 10 years or so. We have several ICU and ER nurses who have been trained and are super users. Any RN can place IVs with US if you get one of the super users to teach you. I would guess that about half of our ICU and ER nurses are trained in the use of US for IV placment.

    All our PICC nurses are ICU staff nurses who do PICCs and art lines as an extra duty. In 2010 we recieved training and have privlages to plave IJ central lines with US guidence.

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