dknunges

I have been a IV nurse (CRNI) for > 17 years and have never heard of such a thing. It certainly is not supported by INS Standards of Practice.

A couple of tricks I have learned from starting IV's on people with fragile veins, no SQ tissue or rolling veins: Instead of using a tourniquet, I use a blood pressure cuff pump up to 20 below diastolic pressure. This makes for an even distribution of pressure and will be less likely to cause veins to blow. Stabilization of veins and keeping skin taught is key. I do this by wrapping my hand around the underside of arm which also allows to enter vein at a low enough angle by not having to work around my own fingers or thimb Using the indirect method of starting an IV works well. This is done by entering the skin to the side of the vein, taking a breath, then angling needle towards the vein slowly until you get a flash. When you are using a tourniquet make sure you do not leave it in place for longer than 2 minutes. If it is left on for longer, it can cause over extension of the vein which cause veins to "go flat". So place the toruniquet on to locate the vein, release but leave in place while you prepare for veinpuncture. Re-apply just before you are ready to access the vein. Try to avoid the AC because this is a frequently used site for drawing blood as well as IV starts in ED. With that being said there is scar tissue that has formed there which is very difficult to thread a catheter through. Just my two cents Donna

According to INS' latest Infusion Nursing Standards of Practice Jan/Feb 2006 Standard 9. Physicians or Authorized prescribers order and initiation of therapy. * 9.6 Prior to initiation of therapy, a Keep Vein Open (KVO) order shall contain a specific infusion rate.

Elena 15 Don't forget the INS Standards Jan/Feb 2006. Standard 45 H under Practice Criteria (pp S47-S48)

I agree, this should be determined by what LPN's are allowed to do by the State Board of Nurisng. I would not let the RN bully you into doing something that it outside your allowed scope of practice because it could cause you to loose your license.

Pre-filled NS syringes are intend for single patient/single use not multiple use on a singles patient. She might think she is saving money and she may well be until the patient gets a Catheter related blood stream infection which in turn could cost $ by treating said infection, increased length of stay etc.

The Intravenous Nurses Society publishes the Standards of Practice of IV therapy. These set the bar for all IV therapy practice. A good place to start! You can order from the web site: http://www.ins1.org

If the hospital you are working for a BD customers using their IV catheters, they offer a wide variety of IV classes for beginners (free CEU's too). They are from 2-8 hrs and on several topics. You will not be certified but better qualified to start IV's. You will only become more confident with each real IV you start on a patient. Talk to your unit manager and have them set up a day or two for you to spend in those high volume areas such as IV Team, Pre-Op, GI lab etc. You could contact your local BD Rep (Materials Management, Infection Control should know who they are) to find out more about this program.

There are many, many medications out there that are incompatible with other meds, even Heparin. It is best practice to always flush with Saline first before giving any med, and then again afterwards followed by Heparin (if this is your policy). This will hopefully prevent any crystalization/precipitation from forming and also check patency of the line before giving a potentially dangerous drug that could cause severe extravasation. Donna

1. Eating popcorn ot of a emesis basin or clean bedpan is perfectly normal 2. You baste your Thanksgiving Turkey with a Toomey syringe 3. You avoid unhealthy looking shoppers in the mall for fear that they will drop near you and you'll have to perform CPR on your day off 4. To be right is only half the battle, to convince the physician is more difficult 5. You have the same bladder capacity as a Winnebago gas tank 6. You get excited when you get old antique medical device's as gifts :chuckle

If no one is willing to share you can obtain Infusion Therapy Policy and Procedures, published by INS (Intravenous Nurses Society) as well as Standard of Practice. Both are good for using as guidelines when writing institution P&P. Go to ins1.org for more info.

The Intravenous Nurses Society (INS) has Standards of Care and Policy and Procedures specifically for IV therapy including Ports that you can use as guideline when writing protocals. You can purchase them on the website. http://www.ins1.org

According to INS (Intravenous Nurses Society) local anesthesia should not be used routinely. As far as a policy for infusion therapy to use as a guideline in your institution INS have published Policy and Procedures for Infusion Therapy. You can purchase by going to the INS web site at www. ins1.org. Both the Standards and P&P can seem costly but a good investment. Hope this helps

Hopefully this will answer you question vague1. According to ISMP (Institute of Safe Medication Practices) and FDA the push for use of oral syringes to administer liquid oral medication is to prevent inadvertant choking on tip caps and giving oral medication IV or IM. You can find further inforamtion and articles at the following web site: http://www.ismp.org/msaarticles/cap.html http://www.ismp.org/msaarticles/nearfatal.html http://www.ismp.org/consumer/syringecap.html http://www.fda.gov/cdrh/fusenews/ufb38.pdf http://www.fda.gov/fdac/features/196_kid.html http://www.ahrq.gov/consumer/20tipkid.html

I agree with Jessica, you are only as old as you feel. I think that if this is what you want to do, then go for it. When I was in school the oldest in my class was 69.....She graduated and passed boards and went to work in Well Baby Nursery. She said she needed those babies since all of her 15 kids were grown and out on their own Good luck Donna

Just one of the may traits of a truely good nurse

The nurse you speak of sounds like the very first nurse I worked for after I graduated. After working with her for several months I decided this is the type of nurse I want to be. She was a role model for me and I have always strived to be like her. To this day I think about her often (after 25 years) and ask myself what Harryett would do in this situation!

Congrats on your newest addition to your family. Your life will never be the same. By the way what did you name her?

I have had my insurance through NSO for almost 25 yrs. When I was in nusring school they required it. When I graduated I then flipped the policy from student to nurse. There are different types of of insurance, forgiving for not remembering the names, but be aware of which you are purchasing. The one that you want will cover you whenever you are sued (20 yrs after the fact) as long as the insurance was in affect when the incident occured. The other will cover you only if you still have insurance on the date you are sued. Which means if you retire, in order to be safe you must continue to carry insurance even if you no long work. I've had many diccusions regarding pro's and con's about having insurance and my thought is that I will continue to carry insurance. I do not believe that if you DO NOT have insurance you WILL NOT be sued because people will sue for anything now days. Common sence tells me that when I order coffee I wouldn't want it if it wasn't HOT!!!!! If I give up 1 Starbuck's Latte a week for 6 months it's paid for.

I to think the hardest thing was fluid and electrolyte, the next hardest was making all the med cards and learning every med the patient was on. By the time I got through I had a stack of med cards (4X6 pre-printed) 6 inches thick..

You are right in that it will require alot of hard work. How old are your children? When I went to LPN school my oldest daughter was in first grade and when I was in RN school my youngest was in Kinder. We made a date every night to study together. Granted it was only a few minutes for them but they each knew that that was our time together and that satisfied them and they would then be kept occupied by their dad while I really got down and studied. We always had a planned activity for a couple of hours on the weekend regardless of how much I needed to study I never let it make me give up our family time on the weekend. I also had a great husband. This worked for me. It is very stressful but start early to prepare the young ones for the time your studies will take you away from them Good Luck Donna

A good way to be a little more descriptive but not to wordy is chart abdomin distended with abdominal girth of ___ inches at umbilicus. Hope this helps Donna

With today's cut backs and budget crunches alot of hospitals have dissolved the IV teams. What I have found visiting hundreds of hospitals in multiple states is that hospitals that still do have IV teams have cut them back to day shift only. They also have turned over starting PIV's back to the floor/unit clinicians and have IV team's focus on inserting PICC's and maintaining extended dwell catheter (dressing changes etc). Not secific to CA but a little information on IV teams Donna

One specific problem associated with positive pressure values tends to be problems with increase of catheter related blood stream infections (CR-BSI). Stick down and leakage has also been reported. bobnurse I can e-mail you a couple of articles if you are interested. Just let me know Donna

Mike, Thanks. This question was asked during a class on IV therapy I was giving a couple weeks ago and I had no conclusive answer due to all the speculation that has floated around for many years. I have filed your response in my memory bank Donna