Rexie68

I'm an RN on the IV team at a hospital. We very rarely suture in our PICCs. Our home health care agencies have had no trouble getting Statlocks and we've had no trouble with that. The statlocks that we use don't tear other than the original one in the PICC kit....that ones seems to be made of a foam-like material while the stock Statlocks are made of a cloth-like material and don't rip.

All 27 nurses on our IV team are trained to insert peripheral IV's using ultrasound guidance. I can't imagine why your manager wondered if it were in your scope of practice...it's non invasive and you're not diagnosing anything. Our LPNs also use it when needed. I can't imagine not having that tool to help with very difficult IV sticks. We don't have a specific policy, just that the nurses need to be trained to use it before doing it independently. Good luck...and you'll be so happy you are using it!

In a horrible twist of fate, my 17 year old step-daughter was in a major car accident (recovering now and hopefully all will be well in time) and has a PICC line. I'm an RN on the IV team and insert and care for PICCs all the time. I guess I never realized that there is such an opposition to them in some departments of our hospital. Radiology didn't want to use it (it's a power PICC and OK for use for everything except gadolineum (?sp)), the OR didn't want to use it, and some of the nurses were upset that she's a nurse draw for labs. This poor kid has horrible veins and doesn't need any more pokes....my colleagues had trouble getting a 4 french in. I can't imagine how many times she would have been poked by now if I weren't insisting that they use the PICC. Does anyone else run into this?? I would have laughed if it hadn't been so ridiculous when the pre-op nurses said "well, we don't use PICCs. the meds don't get into the pts system as quickly as an IV!" Practically had to throw myself on top of her to prevent a poke and anesthesia finally agreed that the PICC was adequate access (and if they did have to add another line, wait until she's asleep). OK, done ranting, but is it just at my facility or do you find it elsewhere?

Well, we can agree to disagree. My facility does not repair any central lines....not picc, dialysis, presep, multi-lumen, etc etc etc. It works for us. We're very lucky to have a "specials" unit that has a physician who works under flouroscopy to place/replace any line that IV team or the docs on the units can't get with ultrasound guidance. Our central line infection rate is less than .05% so we must be doing something right!

I would have done the exact same thing. Much less likely that "germs" will infect a new PICC placed under max-barrier precautions than a PICC found with the cap off. We would also do the same thing if a PICC were found with the dressing off. Again, perhaps some think it's overkill, but it works for us. We're very, very protective of any of our central lines and have an infection rate to prove it works.

Untrue. Once it's mentioned in the nurses notes, it can be used in court. It's happened to my employer and that's why they'll go so far as to fire someone if they chart anything about an incident report. It's only a confidential, in-house document unless it is in the chart. Anything in the chart is fair game.

Every facility I've ever worked in would has a policy that you NEVER mention incident report in nurses notes. Perhaps some you worked at don't care if it's pulled into court, but most would. I'd be seriously reprimanded and perhaps even fired if I mentioned an incident report in my notes. We just chart what happened. The incident report is an internal report and really has no bearing on the patient or their care.

Never, ever, mention "incident form" or incident report in your nurses notes. The form is for in facility use but if you mention it in your nurses notes it can then be pulled into court in the event of a lawsuit!

I only know that 90-95% of our EMS pts come in with an IV...never smaller than a 20 gauge and usually an 18 gauge and most likely in the AC or hand. We change them within 48 hours....if they last that long. Even if the site was placed in another hospital, we change it within 48 hours since we're now responsible for that site. Also, if we place an IV emergently we also replace it ASAP since asceptic technique isn't our top priority when someone is crashing.

I'm so glad you brought that up....I'm SO tired of people saying things like that! Ummm....we see the docs when they're sweaty, icky, bedhead gross and they see us with our hair back in a ponytail and no makeup and oh-so-flattering scrubs and neither one of us has time to pee let alone grab a quickie in the stairwell!!

glad you found your calling and are paid well for it! i took a $3/hour pay cut when i went from an lpn in ltc to an rn in acute care....but that was my choice because i wanted something different. god bless you for sticking with it!

[color=dimgray]perhaps a bit off topic, though i don't think so, because it's another example of someone not "getting it." i'm a nurse on the iv team. most of the time i can get an iv in just about anyone. today, i was attempting to put an iv in a patient and, for one reason or another, i tried twice and just couldn't get in. certainly uncomfortable for the patient and embarrassing for me, but it does happen sometimes....no one is perfect. the patient had a sitter and the sitter looked at me and said "are you a rookie? why don't you go for the ac? my dad puts in ivs and he makes it look easy." i just bit my tongue and left the room because if i had said anything it would have been inappropriate. my coworker returned to the room and was able to get an iv in. she then pulled the sitter aside and explained to him that his statement was inappropriate and upsetting. his response was "well, i was being an advocate for my patient. she was hurting him." my coworker was very polite but reminded him that ivs hurt and that i was doing my job and, that he was a sitter/pca, not a nurse and should not be criticizing me. hats off to her for having my back. the pca/sitter "just didn't get it."

i'm sure those who aren't nurses can empathize with some of our feelings, but unless you've walked in our shoes, you have no idea what we go through. it's a job unlike any other. i'm not saying it's more important than others, but it is unique unto itself and those who haven't done it can't possibly totally understand......though they could at least give us a thank you and a place to vent without fear of being scolded. and, obviously, if you're not agreeing with the majority, you're not "getting it"....meaning you're not getting how we feel.

sorry!! i'm an iv team rn. we replace all pre-hospital iv's within 48 hours....even if they were placed in another hospital. we have a 24/7 iv team that can insert iv's with ultrasound guidance if needed and/or insert a picc, and our docs can put in a central line at any time. 98% of the time we can get you an iv and almost the same percentage of the time i can put in a picc. if you need access fast and we can't get it, the doc can do a femoral line. for ivs that are started in our hospital, we replace them every 96 hours and/or prn.

i'm an iv team rn. we replace all pre-hospital iv's within 48 hours....even if they were placed in another hospital. we have a 24/7 iv team that can insert iv's with ultrasound guidance if needed and/or insert a picc, and our docs can put in a central line at any time. 98% of the time we can get you an iv and almost the same percentage of the time i can put in a picc. if you need access fast and we can't get it, the doc can do a femoral line. for ivs that are started in our hospital, we replace them every 96 hours and/or prn.

i'm sure it wasn't pretty at all.....i can't imagine not having an iv team.....how in the world do the people with no veins get their ivs? who puts in the picc lines or does central line care? mediports? synchromeds? yikes!! scary stuff to me. :nurse:sometimes i wish i were back on the floor or in the icu, but i do like the diversity of going everywhere in the hospital, and inserting picc lines is super fun, so i guess i'll keep doing this for now.

eh, i'll wait for my doc as long as i need to, because i know that when it's my turn, he'll sit down and listen to me. sometimes that means i read a few chapters of a book before i see him, but he'll spend 45 minutes with me if needed. i find that kind of compassion worth the wait.

Wow. Where to start? I am very lucky to work in a facility that has wonderful nursing assistants (we call them PCA's, patient care assistants) on all med/surg floors and ICUs. They do almost all of the bathing but the nurses help when they can. That being said, I'm an RN on the IV team. When I'm in the room with a patient and they mention that they need to go to the bathroom or need cleaned up, I turn the call bell on for them or let the nurse or PCA know. I don't take them to the bathroom, put them on the bedpan, bring them food/drinks, etc. There are two reasons: First and foremost...I don't have the time. I carry a beeper and cover several units at a time and am almost always a few calls behind; Second, I don't know how the pt transfers, if they're on I & O, etc. I know it sounds awful to say "it's not my job", but honestly....it isn't. I'm there to insert IV's, draw labs when needed, insert PICC lines, assist with central line insertions, trouble shoot IV/PICC/central line problems, draw all central blood cultures, discontinue all central lines, care for dialysis catheters, access and deaccess mediports, respond to all codes and rapid response calls, and be available for staff nurses with any IV/PICC/CL/PCA/Mediport/Synchromed/Epidural questions or problems. Perhaps I don't look busy to some staff members, but please walk in my shoes for a day before you growl at me for not helping a pt to the bathroom. If I walked your pt to the BR, another pt would be writhing in pain waiting for their meds, or have a blood sugar of 44 and no IV access.......you get my drift. I have to prioritize, and getting Mrs. Smith a pitcher of ice water isn't high on my list. =/

same here......all private rooms at my hospital.

And I always thought most nurses have OCD......on our IV team we swear we all have it! You know...check, check, check......check again.......check. OK, let's put the PICC in.....PICC assistant nurse comes along.....check, check, check.....just one more....check. LOL. That, and we can't stand not to get an IV in....or leave something for the next shift to do. And then....check.....

No, we don't think doctors jobs are any less crucial than ours, but this is ALLNURSES.COM, not alldoctors.com. And we're not "waiting for the doc to give us orders".....we're following an orderset or hospital protocol. Even if we don't have an orderset or protocol to follow.....while we're "waiting for orders" we're also doing our admission patient assessment (which can take over an hour), putting in an IV, dealing with our new pts family members....oh, and taking care of our 4-6 other patients (on a regular nursing floor). Put us in the ICU and we have a whole different set of protocols we follow....so the patient is on oxygen, has 2-3 IVs in, labs drawn, xrays done, wounds assessed and dressed.....you get my drift. I also don't think we're going to wait for doctors orders when our pt is c/o chest pain...we're going to get an EKG stat, put on oxygen, give nitro/baby aspirin, etc (if appropriate...we're ACLS certified...), draw labs and have it all ready when the doc gets there! I think our docs would be pretty darned upset if we sat there and held the pts hand whlle we "waited for orders." Nurses also frequently give our recommendations to the docs...and the docs appreciate it! In my specialty, most docs don't know how we put in a PICC line, or what meds have to be given via central line (other than the obvious), etc so they ask "what would you recommend." Doctors are invaluable, obviously. Most are very happy that they can rely on us to be their eyes and ears. If I'm not using my observation and assessment skills to notice that the pt is crashing and call the doc, there's not much he's going to be able to do. We need doctors.....doctors need nurses. Thank goodness most of the docs I work with would laugh at much of Morpheds post.

i'm guessing it was the old, analog cell phones that interfered with things, because our icus issue cell phones to the nurses for their shifts.

I'll admit I keep my cell phone in my pocket when at work....most of us do. It's on vibrate and if goes off I'll check it at my next available free moment. I don't answer in a pts room and I don't text in pt care areas. I will text when I'm in a non-patient area if needed. I have teenagers....they don't "call".....they text. I'm not even sure they know what that call button on their phones are for! It works for our facility. Heck, the nurses on the floors have hospital issued cell phones during their shift to be easily reachable. As far as the internet goes, our facility has most sites blocked...no facebook or ebay; you can google things though. I think part of it is a generation thing. Of course no one should be texting or answering their phones in pt rooms, but I think we have to face the fact that cell phones are here to stay. Most in their teens and twenties will not be separated from their cell phones......and this forty-something won't be either!

acls was included in our rn training. we had to take a dysrhythmia course first, and then had acls classes in our curriculum and had to pass the megacode to get our card. it was very valuable to be able to apply for jobs and say that i was already acls certified.