What constitutes an IV insertion "attempt"?

[MunoRN]

This is a spin-off from this thread: Student attempted IV 7 times, alone - General Nursing - allnurses®

The common rule to IV attempts is that each practitioner gets two "attempts", and once 1, 2, or 3 practitioners have failed in their two "attempts", the patient is referred to either a vascular access specialist or the LIP.  

So what is an "attempt"?

I've always considered an attempt to be a single poke and advancement of the catheter, although I do allow myself one 're-aiming' of the catheter if the vein rolls and I feel confident I have the vein cornered and can cannulate it with a single change of direction.

Yet when I do get a vascular access RN involved there is far more 'rooting around' than what I do, although so long as they have some basis for this and they end up being successful I can't really argue.  And then there's Ultrasound guided insertion which kind of has to involve some 'rooting around'.  

So what defines an attempt?  If the tip comes back out of the epidermis is that really that different than if the tip is just a few micrometers from the surface?  If so, Why?

[Corey Narry, MSN, RN, NP]

Just curious, what is the training for IV insertion for RN's these days? I have been an NP for 16 years and everyday I get calls from RN's about a need for IV insertion.  As part of the ICU team of ACNP's, we have been quite accommodating with these requests and would actually come up to the bedside to do the IV insertion ourselves (sometimes using ultrasound guidance). However, I feel like in some instances, the RN's didn't even try on their own. I recently left the ICU NP position so I'm relieved I won't ever get these calls.

[TheMoonisMyLantern, ADN, LPN, RN]

46 minutes ago, juan de la cruz said:

Just curious, what is the training for IV insertion for RN's these days? I have been an NP for 16 years and everyday I get calls from RN's about a need for IV insertion.  As part of the ICU team of ACNP's, we have been quite accommodating with these requests and would actually come up to the bedside to do the IV insertion ourselves (sometimes using ultrasound guidance). However, I feel like in some instances, the RN's didn't even try on their own. I recently left the ICU NP position so I'm relieved I won't ever get these calls.

Minimal training in school with IV's you demonstrate it on a manican arm to get checked off. I was lucky, when I got out of school my employer sent me to outpatient surgery for a couple days where all I did was IV starts under the mentorship of one of the nurses there. It was a wonderful experience, ultimately it really didn't help me much but like I said earlier I'm just not good at it. However I always make an attempt before calling someone better to start the IV, I usually won't stick more than once because with me if I didn't get it the first time I'm probably not going to the second and I don't want to ruin all the good sites for potential placement.

I am seeing a trend of newer nurses not making the attempt first and not having the supplies in the room for the person starting the IV. That drives me nuts, if someone is being kind enough to start your IV, have everything they're going to need in the room at the very least.

[JKL33]

40 minutes ago, juan de la cruz said:

However, I feel like in some instances, the RN's didn't even try on their own.

Seems like a combination of issues and circumstances have brought us to where we are...

How many of us practiced on someone before attempting an IV insertion on a patient? I did. A nurse allowed me to insert an IV catheter on her, and I brought an angiocath home and started one on my spouse (not injecting anything in either case, just successfully pierced the vein and advanced the catheter and withdrew the needle). Can you imagine? I'd probably be barred from ever entering the nursing profession if I got caught doing something like that in 2021. I stole supplies from someone (hospital probably), used a medical device without a prescription and without a license to do so. I've allowed other students/new nurses to puncture my veins on occasion, too. I still have no problem with these practice attempts and believe it's just a matter of fake fear of legal ramifications and illogical concern about wasting time and supplies that has made these experience out to be practically criminal acts.

Then there's the issue of time. There's no time to take anyone aside and let them have these experiences. There's no time for proctoring anyone even if they clearly can't hit the broad side of a barn. And it would be wasting and stealing supplies in order to let them do it. (Nevermind the fact that supplies and time are still "wasted" if they can't start IVs on patients, too).

Then there are all the people who write stuff like this off as skills that anyone can do and proclaim that they are not an important part of nursing; not what nursing is about. Well, yes, starting an IV may not be what nursing is about, but one neither looks nor feels very confident about not being able to do something "anyone" can be trained to do. And if you're the person whose tissues endure the pain of the jabbing and digging and repeated missing of the vein, you'd certainly wish that the person who is licensed to do this task had been allowed the time and proctoring to learn how to do it. I once had an RN of several years' experience try 4 times to start an IV on me by completely advancing the needle. To the hub. Until I finally asked ever-so-gingerly if I could provide a few tips to help the process. Tip #1: The needle can't go all the way into my arm, please.

No one wants to invest in nurses. Even schools are shirking their responsibilities now.

[TheMoonisMyLantern, ADN, LPN, RN]

6 minutes ago, JKL33 said:

Seems like a combination of issues and circumstances have brought us to where we are...

How many of us practiced on someone before attempting an IV insertion on a patient? I did. A nurse allowed me to insert an IV catheter on her, and I brought an angiocath home and started one on my spouse (not injecting anything in either case, just successfully pierced the vein and advanced the catheter and withdrew the needle). Can you imagine? I'd probably be barred from ever entering the nursing profession if I got caught doing something like that in 2021. I stole supplies from someone (hospital probably), used a medical device without a prescription and without a license to do so. I've allowed other students/new nurses to puncture my veins on occasion, too. I still have no problem with these practice attempts and believe it's just a matter of fake fear of legal ramifications and illogical concern about wasting time and supplies that has made these experience out to be practically criminal acts.

Then there's the issue of time. There's no time to take anyone aside and let them have these experiences. There's no time for proctoring anyone even if they clearly can't hit the broad side of a barn. And it would be wasting and stealing supplies in order to let them do it. (Nevermind the fact that supplies and time are still "wasted" if they can't start IVs on patients, too).

Then there are all the people who write stuff like this off as skills that anyone can do and proclaim that they are not an important part of nursing; not what nursing is about. Well, yes, starting an IV may not be what nursing is about, but one neither looks nor feels very confident about not being able to do something "anyone" can be trained to do. And if you're the person whose tissues endure the pain of the jabbing and digging and repeated missing of the vein, you'd certainly wish that the person who is licensed to do this task had been allowed the time and proctoring to learn how to do it. I once had an RN of several years' experience try 4 times to start an IV on me by completely advancing the needle. To the hub. Until I finally asked ever-so-gingerly if I could provide a few tips to help the process. Tip #1: The needle can't go all the way into my arm, please.

No one wants to invest in nurses. Even schools are shirking their responsibilities now.

You make a lot of really good points. Staffing is so bare bones now that nurses aren't getting that 1:1 mentoring that is so helpful. Like I said, my success rate is 50/50 but the day I was partnered with that nurse in Outpatient Surgery and receiving her guidance I hit everyone I stuck. Maybe it was luck, or maybe it was because I had access to an expert. It was an awesome experience, I just wish I was stronger with that skill than what I am because it is an incredibly important skill in nursing.

We all have our strengths and weaknesses I suppose.

[JKL33]

1 minute ago, TheMoonisMyLantern said:

We all have our strengths and weaknesses I suppose.

Yes, we do. And that is the point where I agree that starting IVs isn't the be-all-end-all of what makes a nurse. Not at all. People are better and worse at many different pieces of nursing and that is okay.

2 minutes ago, TheMoonisMyLantern said:

Maybe it was luck, or maybe it was because I had access to an expert.

I'm going to go with expert guidance here. I've helped many students and newer nurses successfully start IVs, even some who were practically shaking. It's one of my favorite things to do with students as it is such a boost for them. Choosing the vein and then the stabilizing, the angling, and the not advancing the needle too far are crucial and these are where a real-time proctor can easily guide almost anyone to success. After that it's just a matter of letting the process become routine and increasingly more smooth.

[Hoosier_RN, MSN]

1 hour ago, juan de la cruz said:

Just curious, what is the training for IV insertion for RN's these days? I have been an NP for 16 years and everyday I get calls from RN's about a need for IV insertion.  As part of the ICU team of ACNP's, we have been quite accommodating with these requests and would actually come up to the bedside to do the IV insertion ourselves (sometimes using ultrasound guidance). However, I feel like in some instances, the RN's didn't even try on their own. I recently left the ICU NP position so I'm relieved I won't ever get these calls.

Some hospitals have IV teams and if you're not on that team, not allowed to attempt. Also, same with training. Some require classes to start IVs. So for some, just depends on policy

[Rose_Queen, BSN, MSN, RN]

1 hour ago, juan de la cruz said:

Just curious, what is the training for IV insertion for RN's these days?

Well, I'm sure my facility is different from many others, but here's how it works in mine:

Most RNs do not start IVs. We have an IV team for that.

For the areas that do start their own IVs (procedural/surgical, ER), they are to review a video from the manufacturer and read the policy on IV insertion before attending a hands on skills session where they insert IVs on a mannikin arm. Once they've been signed off on the skills session, they are then paired with an IV team nurse or preop/preprocedural RN where they will have close guidance. They must successfully complete 10 IV starts before they are allowed to begin IV starts on their own, and then must start at least 2 per quarter with an 80% success rate for the year to maintain competency.

[JBMmom, MSN, NP]

We also have an IV team and most nurses on the floors aren't trained/signed off on IV insertion. The OB nurses, ED nurses and ICU nurses are the only ones signed off. They are definitely NOT my strong suit, I'm currently on a bad run, I've missed my last five or six. I have a two stick limit, too, and I count that as two pierces of the skin, then I'm done.