IV starts, blood draws

DavidDudley · Jan 2, 2014

I got some decent experience with IV's when I worked sub-acute SNF and when I was in prison. But nothing compared to the experience I get in the ED.

SoldierNurse22, BSN, RN · Jan 2, 2014

Try an infusion clinic or an outpatient oncology setting.

smartnurse1982 · Jan 2, 2014

Sometimes,an agency will let you start IV's in the home.My current agency,its not permitted to even touch a picc line nor central line,even if you are an RN.Anytime a kid with a broviac needs Tpn started,mom has to do it.Anytime a kid needs a Picc line flushed,mom has to do it.

mluvsgnc · Jan 3, 2014

Take a phlebotomy course. You don't start IVs, but you do get to work with butterfly needles and other types of needles (and of course practice blood draws).

SDALPN · Jan 3, 2014

Depends on the agency. We do everything from TPN/central lines, to IV therapy, to blood draws for labs. Some agencies will teach you. I learned in the hospital. Also depends in the scope of practice in your state. As others said, you could take a phlebotomy course. But the course isn't geared toward nurses. And many are scams, so make sure the school is accredited (just because they say they are, doesn't mean it...). Its not a very common skill in PDN.

ceebeejay · Jan 4, 2014

Thanks. I was wondering about phlebotomy, but it didn't seem like what I was looking for really. The oncology and infusion centers here (LI, NY) all want experience. I would like to be able to do this. I believe our agency is looking to partner with an infusion agency. Perhaps, there will be some opportunity for training later. Haven't run into central lines or PICC's yet in the home setting. Our scope of practice allows RN's to maintain them but not start them unless you have X hours of training and certification.

mluvsgnc · Jan 4, 2014

I took phlebotomy through my college, so it was legit. And even though it isn't starting IVs per se, I think the main thing with IVs is finding the vein and inserting the needle (aka venipuncture), which you get to practice in phlebotomy. It was nice b/c I got to work with people who had difficult veins (fortunately they were willing!), as those are the challenging patients.

You may consider an IV training course, too.

ceebeejay · Jan 5, 2014

I took phlebotomy through my college, so it was legit. And even though it isn't starting IVs per se, I think the main thing with IVs is finding the vein and inserting the needle (aka venipuncture), which you get to practice in phlebotomy. It was nice b/c I got to work with people who had difficult veins (fortunately they were willing!), as those are the challenging patients.
You may consider an IV training course, too.

Yes, I suppose that is true about finding the veins. I will check around. I think my Community College offers it. I will also look for an IV training course. I did not know that those existed; I thought it was only something you could learn in a hospital. Thank you!

KelRN215, BSN, RN · Jan 5, 2014

Sometimes,an agency will let you start IV's in the home.My current agency,its not permitted to even touch a picc line nor central line,even if you are an RN.Anytime a kid with a broviac needs Tpn started,mom has to do it.Anytime a kid needs a Picc line flushed,mom has to do it.

I don't understand. What's the point of having a private duty nurse for a TPN dependent child if the nurse cannot provide the care for the TPN? Why would a family choose to use an agency that won't deal with lines? Who does the dressing changes? What if the kid needs labs?

JustBeachyNurse, LPN · Jan 5, 2014

I don't understand. What's the point of having a private duty nurse for a TPN dependent child if the nurse cannot provide the care for the TPN? Why would a family choose to use an agency that won't deal with lines? Who does the dressing changes? What if the kid needs labs?

Nearly all of my patients' insurance companies require non-STAT labs to be drawn at lab corp or quest diagnostics.

Both of my agencies require nurses to be certified in IV & phlebotomy to insert peripheral catheters whether RN or LPN. One agency offers training. IV certification is also available via the continuing ed at county colleges with nursing programs.

TPN is initiated by RNs and can be monitored by LPN with demonstrated competency. Same with dressing changes.

Supplies are provided by the patients DME company (just like GT kits, dressings, syringes, suction, neb, & trach supplies)

Children with specialized infusion pumps (such as intrathecal baclofen pumps) or limited access ports (i.e. Don't require routine or regular infusions just monthly/bimonthly flushes for patency) may utilize the home infusion services provided by the regional hospital home health department. Especially since the hospital team has the capability of getting the drugs & specialized supplies from the hospital pharmacy.

Oncology patients are taken care of by the hospital infusion home health dept as most of their nurses are chemo certified whereas most pediatric PDN & home health agencies are not.

KelRN215, BSN, RN · Jan 5, 2014

Nearly all of my patients' insurance companies require non-STAT labs to be drawn at lab corp or quest diagnostics.
Both of my agencies require nurses to be certified in IV & phlebotomy to insert peripheral catheters whether RN or LPN. One agency offers training. IV certification is also available via the continuing ed at county colleges with nursing programs.
TPN is initiated by RNs and can be monitored by LPN with demonstrated competency. Same with dressing changes.
Supplies are provided by the patients DME company (just like GT kits, dressings, syringes, suction, neb, & trach supplies)
Children with specialized infusion pumps (such as intrathecal baclofen pumps) or limited access ports (i.e. Don't require routine or regular infusions just monthly/bimonthly flushes for patency) may utilize the home infusion services provided by the regional hospital home health department. Especially since the hospital team has the capability of getting the drugs & specialized supplies from the hospital pharmacy.
Oncology patients are taken care of by the hospital infusion home health dept as most of their nurses are chemo certified whereas most pediatric PDN & home health agencies are not.

That's not how we do things in my state at all. None of the hospitals have their own home health infusion department. All children with cancer are referred to home health agencies for their line maintenance, home labs and, in some cases (mainly ALL), chemotherapy. They also get an infusion pharmacy which supplies the chemo, flushes and all line maintenance supplies. I push chemo all the time in the home. I also draw labs from lines pretty much every single day. The other agencies that take these kids all do it the same way too... I know, because I interviewed with several of them before accepting my current position. We don't do peripheral lines on children in the home and even kids who just need short-term IV therapy (i.e. IV antibiotics for a ruptured appendix or pneumonia) get PICC lines. I pull PICC lines in the home all the time too. I've only ever known of one kid who utilized Quest for her labs and the reason was, we were discharging her from service as she had no skilled nursing needs and only required labs. She was a peripheral stick. I've never known Quest to draw labs off of lines, but- as I said- I have very limited experience with them because I do all my line draws myself.

Anyway, my post was in response to smartnurse1982 stating that nurses in her agency are not allowed to touch the line if the patient has a permanent access. That doesn't make sense to me. My agency has several PDN patients who qualify solely on the basis of needing TPN. Why would you have a nurse in the home for TPN if he/she wasn't allowed to do anything with the TPN? And if the nurses aren't allowed to touch the line, who does the dressing changes? I get that they come from the supply company- they do for my patients too- but I'm the one who changes the dressings and caps. There's no way I would expect any of my kids' parents to do that. Most of them can barely handle giving PO meds.