number of IV starts

[acenab4jc]

Hi,

Just a few questions:

1. How many PIV start attempts are allowed per person at one time for a single patient?

2. How many PIV sticks are allowed per patient in a given time frame? at a time? in a day? in a week?

3. Who does the PIV starts in your unit? Your PICCs?

4. At what point do your doctors choose to place a PICC? What criteria to you have in place for who needs long term IV access? (ie: indefinate NPO status, # days antibiotic therapy, etc)

6. If a patient has criteria to need long term access, how many PIVs does the patient need before the doctors choose to obtain consent to try for long term access?

I think that's all - Thanks so much.

[NicuGal, MSN, RN]

We are allowed 2 sticks per RN. After 6 we tell the docs and they place a PICC or UVC.

Any kid that is going to be on fluids or antibiotics longer than 3 days almost always gets a PICC. Our fellows or NNP's place our PICCs, if the can't get one then IR comes up and places a femoral one at the bedside. All of our admits have a permit for long term lines upon admission, so if we need on emergently and we can't get hold of the parents we can just do it. The only exception is the one from IR, they always get their own.

[goshenc1]

Same as NicuGal for the most part. We do the PIVs-2x per RN, 6 times for the RNs then notify NNP/MD. Usually they'll try at that point for a PIV as well. Frequent meds, antibiotics, long term therapy, etc will be candidates for PICCs. PICC nurses (special certs and classes), NNP, or MDs do ours. We don't have IR come up and do them unfortunately. Not all our kids have PICC consents- some parents refuse, some are too out of it to consent at time of admission, etc. We have to get them whenever possible and as early as possible.

[Jory, MSN, APRN, CNM]

Here is our policy:

1. Two sticks per RN

2. 5 sticks PICC placement

3. All babies get UVC's on admission UNLESS they think the baby will be on full-feeds in 3 days.

NNP's do all the PICC placements and the Neo's do the UVC's unless it's an admission, then the NNP's do them.

[acenab4jc]

Thanks for the input - we are trying to put together a policy because we have been seeing too many kids being stuck too many times (think 27 times between 2 kids one night, between RN's, MD, and IV team - aweful) and I know a lot of it is because the med team pushes off putting in a PICC because "look they got another PIV, they're ok" when really, the kid needs something before they have nothing, then surgery is forced to place a broviac (with minimal options for pivs during surgery) because now all the PICC options have been used up.

[krenee]

I work at two hospitals. First one is a smaller level II NICU and the RNs get 2 sticks apiece. There are usually only two RNs working. Then we call the NNP. There doesn't appear to be a rule about how many times the NNP can try, and I've seen kids get stuck WAY too many times. PICCs are greatly under-used in this NICU in my opinion.

My other hospital is a level III and when I asked how many tries we get, I was told "until we get it". PICCs also under-used in this facility. But the RNs seem to be better at it, probably due to the micro-preemies and such that we get, so the kids don't as often seem to be "tortured". I think it's a good idea to come up with a policy and I may suggest it myself.

[NicuGal, MSN, RN]

Our policy changed when our sepsis numbers started to rise due to all the sticks.