UAP d/c-ing peripheral IV's

[Lorien_LPN]

Hey nurses,

I am in my last semester of RN school and we are discussing and researching the prevalence in my area hospitals of delegating to UAP's the removal of peripheral IV's. I have looked at the policy and procedures of two of the major hospitals, both Trauma II and both have almost a thousand beds. Both insitutions provide in their P&Ps for the UAPs to remove peripheral IVs. One of the insititutions includes removing peripheral IVs in their nurse technitian course they use to train new UAPs.The major issue that has arisen from this is a recent incidence of a UAP removing a catheter but a part of the catheter remained inside the patient's risk requiring the patient to return a week later with a severe infection.

My question to you guys is at your facility is it permitted for UAPs to remove peripheral IVs? This is just out of curiousity not for a school project.

[talaxandra]

Obviously practice in Australia is very differnet from where you are, because I don't know what a UAP is (but assume it's some kind of minimally-trained aide role?). In over twenty years I've never seen any part of a peripheral cannula retained in the patient, and I've had a lot of lines (peripheral, PICC, CVC, vascaths, chest tubes) removed by wholly-untrained patients.

I'm certainly not saying it doesn't happen, and maybe the equipment these hopsitals is using is quite different from the cannulae my hospital uses. Or perhaps I've got entirely the wrong picture here?

[barbyann]

I find that the my neuro patients tend to dc them at greater frequency and at a faster rate than my techs. just saying.....

[Esme12, ASN, BSN, RN]

Obviously practice in Australia is very differnet from where you are, because I don't know what a UAP is (but assume it's some kind of minimally-trained aide role?). In over twenty years I've never seen any part of a peripheral cannula retained in the patient, and I've had a lot of lines (peripheral, PICC, CVC, vascaths, chest tubes) removed by wholly-untrained patients.

I'm certainly not saying it doesn't happen, and maybe the equipment these hopsitals is using is quite different from the cannulae my hospital uses. Or perhaps I've got entirely the wrong picture here?

I love that..... It's perfect!

Yes...UAP...Unlicensed Assistive Personel. The equpitment as far as IV lines are pretty standard. I agree I have seen many, many lines removed and never saw one "leave a little behind". Do I look at every cath when I remove it? Absolutely. I have however seen some shirred of by the inserting MD. If the UAP is trained there is no reason not to allow them to remove the line.

I still smell homework...but I found a decision making tree for the use of UAP.....so here it is.

http://kbn.ky.gov/NR/rdonlyres/E1591ED0-5C3E-425C-ACE6-396268CE1774/0/DecisionTreeforDelegationtoUAP.pdf

[wooh, BSN, RN]

If an untrained 7 day old infant can remove an IV, surely a trained tech can remove one.

A piece broke off? I remember being warned that can happen when a NURSE inserting the IV pulls the needle back then pushes it back into the catheter during insertion. Or with a faulty IV catheter. Neither of which would change if a NURSE took the IV out. But sure, let's blame it on the tech that took it out.

[esrun00]

Our hospital allows trained techs to remove pivs. Never had a problem.

On another note, had a patient about 10 years ago remove her own iv (being helpful) and she broke off the canula, it was a Saf-T-Intima. She had to go to surgery to have it removed.

[bmathis]

I dont think its "blaming" the techs. It is just that they may not know to look to see if the cath is intact or not and what it could cause if a piece was missing. "Assessing" is the nurses job, and ultimately the patients condition is the nurses responsibility. So after dc'ing an iv we need to assess the cath and bleeding. On my floor we do not let techs remove iv's, but I think our ER may...?

[bmathis]

At our hospital, in the ER, I think they are also starting to let techs draw blood...has anyone else has techs drawing blood?

[Penelope_Pitstop, BSN, RN]

At our hospital, in the ER, I think they are also starting to let techs draw blood...has anyone else has techs drawing blood?

If techs at my institution take the phlebotomy class, they can draw blood.

[WillowNMe]

I work at a level 1 trauma hospital and our CNAs pull IVs. If a catheter got left behind, it sounds to me like it wasn't inserted properly.

[wooh, BSN, RN]

I dont think its "blaming" the techs. It is just that they may not know to look to see if the cath is intact or not and what it could cause if a piece was missing. "Assessing" is the nurses job, and ultimately the patients condition is the nurses responsibility...

And "diagnosing" is the MD's job, and the MD is ultimately responsible, so maybe we should have the doctors come dc the IVs, since I can "assess" the cannula, but only a doctor can diagnose a fully removed cannula...

We have a new hospitalist that was all excited when I told her she didn't have to dc a PICC line herself, apparently where she did her residency, they made the docs do it.

We can say everything is the nurse's responsibility. Perhaps only the nurse should deliver meal trays (after all, what if some green beans got by that were only half pureed.) Perhaps only the nurse should wipe butts and turn patients. There are some on here that insist on doing their own vital signs. But at some point we have to trust people to do their job. You teach the tech to watch and make sure the whole cannula came out and to alert someone if it doesn't. We can't be everywhere and do everything.

[bmathis]

I do understand we cannot do everything. :) There is just a risk of infection and hematoma. Techs may not know a pt is on a heavy dose blood thinner and may not hold pressure long enough, or put a BP cuff on the same arm as the dc'd iv for one last set of vitals and cause a hematoma. My point: sure, if they are trained let them do it! But, it is not that hard to stop in and say good bye to the pt while peeking at the old iv site.