Treatment of vulnerable patients

[LibraNurse27, BSN, RN]

Hi All nurses! I have been a nurse for almost 5 years and have previously felt that I am great at making connections with patients, making them feel cared for and treating all my patients very well. I work at a county hospital and we take care of many homeless patients, dementia and psych patients and other vulnerable populations. Today my patient had cognitive deficits due to a stroke and was extremely drowsy. I attempted to place an IV and was unsuccessful three times. The patient slept through all of the attempts and later when he was more awake stated he did not remember any of it. I am just upset with myself because I usually try a max of two times for an IV and if still unsuccessful go for help. I feel like I took advantage of this patient because of his drowsiness and his cognitive deficits and I feel really terrible. Am I overreacting? Going forward I will stick with my "two strikes" rule and be extra aware of how I treat confused/sedated patients. Thanks for any input

[cardiacfreak, ADN]

It seems like you have this figured out yourself. Don't beat yourself up.

[brownbook]

I have never seen it written in stone, or even paper, that only two sticks are allowed per nurse!

Yes, two sticks is kinda sorta a good limit for nurses to go by. I find I am so annoyed and frustrated after two I just know the third try is going to fail and my ego will be shot! To say nothing of the poor patient.

I had a patient tell me he knew his nurse was new. She blew two IV sticks, apologized, was going to get another nurse. He told her no, to try again! She got it on the third try.

If you absolutely have to try three times, (for whatever reason), take a break first, sit down a few minutes, drink some water, etc.

[amoLucia]

I'd say relax! Attempting 3 times to start an IV is NOT worthy of your punishing yourself. I'm going out on a limb here to say I doubt you were 'stabbing' at your pt and were trying to be as clinically adept as you could be.

I'm sure many of us out here have had to try more than twice, esp when an IV was critical to a pt's care. Sometimes there are NO other choices, like when there's NO other IV certified nurse in the facility (like in LTC, you might be it!).

Seriously, you tried your best to do what you had to do.

Go easy on yourself.

BTW, I'm a bad stick. I don't care if the IV nurse or phlebotomist has to try multiple times. They're NOT stabbing at me; I just make a schrunchy face.

[Crush]

Be gentle with yourself. 3 times is certainly not unreasonable.

[LibraNurse27, BSN, RN]

Thanks everyone for the reassurance! I really appreciate your feedback and comments

[brownbook]

BTW, I'm a bad stick. I don't care if the IV nurse or phlebotomist has to try multiple times. They're NOT stabbing at me; I just make a schrunchy face.

I want to see a "selfie" of your schrunchy face!

[Have Nurse, ADN, RN]

Hi All nurses! I have been a nurse for almost 5 years and have previously felt that I am great at making connections with patients, making them feel cared for and treating all my patients very well. I work at a county hospital and we take care of many homeless patients, dementia and psych patients and other vulnerable populations. Today my patient had cognitive deficits due to a stroke and was extremely drowsy. I attempted to place an IV and was unsuccessful three times. The patient slept through all of the attempts and later when he was more awake stated he did not remember any of it. I am just upset with myself because I usually try a max of two times for an IV and if still unsuccessful go for help. I feel like I took advantage of this patient because of his drowsiness and his cognitive deficits and I feel really terrible. Am I overreacting? Going forward I will stick with my "two strikes" rule and be extra aware of how I treat confused/sedated patients. Thanks for any input

I don't know. From what you've shared, to me it really sounds more like you were using your Critical Thinking skills, knowing this person needed the IV, and your skillset. And you didn't cause him any distress.

You were meeting your patients needs.

I too have the same rule, but depending on the situation, there might be exceptions.

[Here.I.Stand, BSN, RN]

When I think of "taking advantage of pt's vulnerability," I think of things like: ignoring a quad's refusal of a med because he can't physically stop you. Using your nurse-pt relationship to fulfill your own emotional needs, or other type boundary crossing. Willful abuse -- including financial abuse. (A nurse in my state lost her licence for that -- she had been financially exploiting her elderly mother.)

He told you himself that he didn't suffer at your hands.

There is no reason to NOT try a 3rd stick -- vulnerable or not.... and in fact, the other RNs are probably busy, and unable to go right at that moment. This means that had you NOT started that IV, his treatment would have been delayed.

[Cat365]

Shall we hang you up by your toenails because you tried 3 times rather than the random number of two times? I usually will try twice, but I've tried 3 times, once, and not at all.

Each situation is different. If I saw a good third chance I would take it. I had a patient the other day that I thoroughly looked at both arms and hands then I called my charge. She called in IV team. I'm convinced this patient had no veins. The blood traveled back to her heart by osmosis.

There was no harm done in your case.

[djh123]

I think a nurse who is conscientious and worries whether they did the right thing is almost always better than the one who never even stops to think about it.

[audreysmagic, RN]

I know the magic two sticks is popular now, but I was taught in school, "After three, let it be," so I've always been OK with 3 attempts. I think it speaks to what a caring nurse you are that you're worrying about this, but I don't think you did anything wrong.