I am a relatively new nurse, less than 6 months, and one thing I noticed that I am still really struggling with is IV insertion. I was looking into taking a course offered for nurses at a local university. The summary of the program stated that it was incorporating information from the Infusion Nurses Society 2010 Standards of Practice, instead of the 2016 edition. Does it matter? Does anyone happen to know the differences between the two editions?
Double tourniquets and warm packs work well. In kids who don't walk, go feet. In newborns, scalps if policy allows. In ED, 18 or 20. Trauma equals two lines. Our policy is the same, two sticks and move on. Ps there is hidden vein over the fourth knuckle on the hand on everyone, but going in blind is not ideal.
Specializes in Labor and Delivery, Medical, Oncology.
As a L&D nurse I start IVs all day long. After my hospital downsized the IV therapy team we are the ones who get called for difficult starts on the med-surg floors. Here's some tips:
-Pick the smallest cath you can get away with. You only need a large gauge cath (18 or 20) for surgery, blood transfusions, or large IV boluses. Otherwise, the smaller, the better. Easier to land, lasts longer, and less damaging to the vein.
-Use veins you can feel. If you can see it, but don't feel it, don't use it unless you have nothing else.
-Try to put it in where two veins converge. Fewer valves in those spots.
-Your angle of approach needs to be shallower than you think.
yes you can start an IV in what I call an alternate location such as a finger, thumb, shoulder, inner wrist etc and in an emergency you may have to, I know I have, but if this is all you can find the Pt probably needs better access such as a midline or a picc line.
Neither of those is an option at my facility on shift. Although we can do extended length (40mm) peripheral angios to access a Basilic or Cephalic. But, if a provider insists a patient needs access(and you agree) & they refuse to put in central, what do you do? Know what I mean? Do what you can with what you've got.
The only real advice I can offer is: use the best vein you find, not the first vein you find; most situations allow the time to search out your best option.
Double tourniquets and warm packs work well. In kids who don't walk, go feet. In newborns, scalps if policy allows. In ED, 18 or 20. Trauma equals two lines. Our policy is the same, two sticks and move on. Ps there is hidden vein over the fourth knuckle on the hand on everyone, but going in blind is not ideal.
Unfortunately my workplace frowns on doing EJ sticks. While I personally view those as a peripheral line (Paramedic scope considers EJ lines as peripheral), my workplace doesn't. As an aside, if someone's neck veins are flat when supine, they're very volume depleted and you'll have a difficult time getting any line anywhere except for those that are very central... or very hard (like an IO).
In response to your questions regarding the Infusion Therapy Standards of Practice (The Standards) published by the Infusion Nurses Society, The Standards are revised every 5 years. The revision of the 2011 Standards was released in January 2016. The Standards is based on the most current evidence and research to support best practices for those who are involved in providing infusion therapy to patients. In planning educational programs and ensuring positive patient outcomes, the Infusion Nurses Society incorporates The Standards in providing the framework of all our educational resources including: policy and procedures, web based education, virtual meetings and national CE conferences. Further information about the Infusion Nurses Society as well as additional resources can be found at www.ins1.org
If you are already working at a hospital then ask to come in one day and get some practice with an old nurse, well not old just one who has a lot of practice..I would say either in the ER or in the Out Patient Surgery department..Most of their days revolve around inserting Ivs..practice makes it a lot easier..Good Luck.
So are you telling us that you use vulnerable patients as your practice "dummies" without their permission and you choose the ones who can't speak presumably so they won't rat you out?!! How on earth do you think that is acceptable at any level? And admitting it on a public forum? What is wrong with you? There was another person in history that did exactly what you are doing. It didn't end well for him.
You still ask their permission. Even family members at bedside. Sometimes these people have IV's that are several days old. I apologize if my original comment left room for your personal interpretation, but most nurses I know will only cater to their own patients. I usually ask other nurses if they need IV's changed so I can change them for them. What's wrong in using the term "practice"? Technically it IS practicing, whithin our scope of practice and ethics. I was never an expert in ultrasound guided IV insertions, so I will term it as "practicing".
I'm sorry you refer to these patients as dummies, they are not dummies.
pedseraprn
36 Posts
Double tourniquets and warm packs work well. In kids who don't walk, go feet. In newborns, scalps if policy allows. In ED, 18 or 20. Trauma equals two lines. Our policy is the same, two sticks and move on. Ps there is hidden vein over the fourth knuckle on the hand on everyone, but going in blind is not ideal.