IV Therapy

i've been an rn and iv therapist for many years. the only reason i can see why it would be inappropriate for an rn student to learn the principles of iv insertion would be (1) if the state law disallowed it, and (2) if there were some preliminary principles that you would have had to be taught first that had been skipped. i don't think that is the case and i know ivs. i've included a link to an article entitled "iv insertion - still a special skill". it discusses the problems of nurses not being proficient in iv starting, the decline and atrition of iv teams and increase in lawsuits secondary to problems related to poor iv insertion technique. speaking from experience. . .i saw many licensed rns who really sucked at iv insertion. it's probably a good idea that your school is starting you out early in learning this skill. it takes months, years, to become proficient in this skill. it took me years to become a master at it. seeing as it is a skill that, in many cases, separates you from all other healthcare personnel (although in many states lpns are now allowed to start ivs too), i, personally, think it's pretty lame when an rn can't do them and really embarrassing if an lpn knows more about ivs than an rn (that is totally my personal opinion and attitude after years and years of doing iv therapy).

• http://www.aic.cuhk.edu.hk/web8/very%20basic%20venous%20cannulation.htm - a very basic pictorial on iv insertion
  
• http://community.nursingspectrum.com/magazinearticles/article.cfm?aid=19901 - iv insertion - still a special skill
  
• http://www.guideline.gov/summary/summary.aspx?doc_id=8338&nbr=004666&string=white+and+blood+and+cell+and+transfusion - access device guidelines: recommendations for nursing practice and education. includes steps of the various procedures.
  
• https://allnurses.com/forums/f18/iv-tips-tricks-3793.html - iv tips and tricks
  
• http://www.ocalaregional.com/cpm/venous.htm - venous access devices self-study module (includes central lines)

That seems odd to me. I'm going into my 3rd semester of my ADN and we start doing that towards the end of the semester.

Read the article "IV Therapy--Still a Special Skill". So many generalist RNs are incredibly bad at starting (and managing) IVs it's not funny. You only have to be a patient for more than 3 or 4 days to realize that. They take people off the street and teach them in a few hours how to stick people to draw blood samples. The difference between that and performing a needle puncture for IV therapy is that in IV therapy you are inserting a rigid needle trocar into a pipe (the vein) and the trocar has to be dead on perfectly seated in the vein. Phlebotomists "blow" veins all the time. As long as they get their blood sample some don't particularly care that they are leaving a patient with a huge hematoma. If a nurse "blows" a vein when inserting an IV, the nurse has to do the procedure all over and interact with the patient as well for the remainder of the shift. It took me at least 6 months of intensively looking for 2 or 3 IVs to start every shift before I started to show improvement in this skill. That was maybe 200 IV starts, if I was lucky to get to do that many. And, I was still only so-so at doing them. I can tell you that many more nurses would rather run and hide or pass the task of restarting an IV on to another nurse who volunteers to do it rather than put in the time and effort to become proficient in this skill. Anyone who thinks that starting 3 IVs makes you skilled at it is kidding themselves. But, I commend them for the success and effort they are putting forth and hope they keep it up. When I worked on an IV team, I started 20 to 30 peripheral IVs in an 8-hour shift, 5 days a week for 6 years (approximately 30,000+ IV starts that I know of). Most staff nurses never come anywhere near those kinds of numbers.

I have had bad experiences with nurses that are not efficient in starting a I.V. The last time I was in the hospital to have my appendix out the nurse stuck me 7 different times before he could initiate a proper I.V. I was not a happy camper. Not to mention that it blew a day later and my arm was swollen with fluid. Talk about the burn. :angryfire

I think that the healthcare industry and nursing leaders probably spurred on by patient survey comments have led to a closer look at IV skills and training of the nursing staff. IV teams used to be more prevalent than they are today. With the rising cost of healthcare and third party payers cutting reimbursement to the bare bones, facilities have had to cut operating costs. IV teams were often the first to feel the axe. It is how I lost my last IV Team job. The hospital just closed the IV team down and put all the IV team nurses into the general staff nursing pool. I can't speak for others, but I found learning and becoming proficient in doing IVs to be very time consuming. Every person's veins are different. This is not a skill where you do a few and can say you are skilled at it. There are too many variables that can exist when trying to access any individual's vein. I think that educators and leaders are beginning to realize it--finally. When I was a nursing supervisor, I spent a good amount of my shift starting IVs when staff nurses had had their two tries and missed. Some supervisors don't feel that way though and believe a nurse should keep trying until they are successful at getting the IV put in. What about the patient? I always said that is was such a waste of time for a patient to be stuck by two different nurses two times each (that's 4 misses and probably an hour of time) before finally calling someone who was an expert at it. However, that was, and in many cases, still is the standing rule in most acute hospitals. It's a stupid rule and when you are the patient, it stinks even more. The Intravenous Nurses Society (INS) is the professional nursing group who writes the IV standards that are incorporated into almost all facility IV policies and procedures. They also offer national certification in this specialty. I was, at one time, a CRNI (Certified RN. Intravenous) through the INS. The certification test was 4 hours long and rigorously tests you over fluid and electrolytes as well as techniques and standards of IV therapy. Contrast this to other nursing skills such as inserting foley catheters or giving IM injections. Ever hear of professional nursing organizations devoted to these skills? I mention that to try to get you all to see the seriousness and importance of IV skills. I was determined to get good at it because I realized how one IV going bad screwed up my work shift just trying to get that problem corrected. It took me years to master it. When you go into practice, you will find that most of your workday is consumed with solving little problems that come up. IV's going bad and needing re-starting is one of those problems. When it becomes a problem that takes up an hour or two of your shift then it becomes an even bigger problem that next to everything else you have to do has then become the biggest thorn in your side that you can imagine. This is when people start crying, get grumpy and snap at coworkers who now think they are eating their young, or, in some cases, they just sweep the problem under the rug (I've seen that all too often) and leave it for the oncoming nurse to deal with.