IV therapy

not a hospice nurse here, but i am an infusion nurse who works for a company that has a hospice (i work for the iv pharmacy).

i put piccs in hospice patients (go out to their homes) for a variety of reasons. pain control is the obvious one, but they also get them for ppn (quick mix, travasol), iv abx, iv hydration, and sometimes phenobarb if the end is near and the patient is very restless.

however, there can be a decent time lag between the time the need for iv access is identified and when the picc is approved for use.....sometimes >24 hours (or even longer).

the hospice nurses often have to place a piv to act as a bridge during this time. and, hospice patients are some of the toughest to get ivs into. they often don't have much left.

however, before i scare you off, let me tell you this: starting ivs in the home setting will do amazing things to your iv skills. when there is *no one* else readily available, it is surprising at how good at starting ivs you will become.

now, all that being said, you will probably see more ports, hickmas, and piccs than peripheral ivs, mostly because you need something that the family can work with. and you don't want the family restarting the iv (obviously :) ), but you also don't want the family to have to assess the iv site for s/sx of infiltration. nor do you want to be running out at 3 am (in the scary part of town) to restart an iv that has gone bad. but, starting ivs is a skill that a hospice nurse needs to have.

Is this for an inpatient unit or home hospice work? Usually peripheral IV's are strongly discouraged because (as stated above) hospice patient's tend to have crappy veins and in a home setting you don't have skilled professionals to monitor for infiltration. Usually IV access is through an established PICC or a port. We don't do very much through IV's at all. 1% of our patients or fewer have IV meds.

I've been a hospice nurse in the home for almost a year and I've never had to use an IV....just ports and picc's.

I've been a hospice nurse for a long time and I've never started a PIV in all these years. We use either central lines or subcutaneous sites. We will not maintain a PIV in the home.

In my agency we do not do IV's. It's one of our regular teaching we try to do. I had a PCG concerend that her husband was dehydrated, mind you he was actively dying. I informed her that a dying body does not need fluids or food to function. She was surprised by this. I also explained that we could start an IV if she so wished but it may be more damaging to the PT than it would be good. She was very understanding. Our code of ethics is to manage pain and symptom control. Dehydration is part of the dying process. I hope this helps.

I have to agree with Prostreetrig. In my agency we do not do IV's, either. When PCG concerend that the pt dehydrated and is actively dying, we remind them of the earlier end of life teaching that ws done (ie: a dying body does not need fluids or food to function). We will hydrate, if the PCG or pt insists, but do explain that to start an IV it may be more damaging to the pt. Dehydration is part of the dying process. One of my pts summed it up beautifully....."I no longer need Earthly food because I'm getting ready for Spiritual food"

Good luck to you!

All good points but we have done IV hydration now and then for families who are struggling mightily and just don't believe what we are telling them. Usually after one bag when they see all the things happen that we predicted (fluid building up in the tissues, wet lung sounds, no improvement in evident comfort) they are able to let go.

I have worked as an RN for 1.5 years in a busy Med surg unit. I have been interested in working as a Hospice nurse. There is a position posted in our local paper - the ad states must have IV skills. What does this mean? Do hospice patients have peripheral IV's? That is my worry because inserting IV's is my downfall. Or, is it mostly PICC's, vas caths etc.

ive only drawn pt/inr & ptt on one patient since doing hospice. Although I have a patient with a chest port, and I access it every 8 weeks to flush and hep lock it (i got an order from her former oncology MD, because the patient insisted--she has stage IV lung ca). I guess its a good thing to request the skill, should the need arise to access a vein for what ever reason...

linda

Just finished with a patient with CA of rectum, liver, kidney, bladder, etc - three ostomies - had a PICC line that we were giving Morphine and Ativan IVP. We have had patients with morphine/dilaudid PCA and intrathecal morphine. Have never had problems.

I have never had to start an IV in the home, we do however use piccs and ports. Mostly for pain control or nausea. We dont do a lot of blood draws either. I think that if you feel like hospice might be your calling, you should go for it. It is a GREAT job!!

And especially in hospice, it would not be very comforting to a patient to have p.i.v, my guess is you will see very few of them. If you had a patient with a order for one, you could probably ask another nurse there to asst you.

We hardly ever use IV access at our hospice. With all the other routes of medication admin, we seldom need to.