Why does a hospital need RNs which are unable to do anything else but starting IV's??

RN-PA, RN · Feb 19, 2004

Every nurse should be proficient in starting IVs. It is a procedure that is both an art and a science.

That's a great concept in an ideal nursing world, but with nurse-to-patient ratios on med-surg of 1:6-7, PLUS higher acuity patients, PLUS covering LPNs' patients, PLUS computer documentation, PLUS many nurses working part-time, becoming proficient at IV starts can be unrealistic for many of us.

As I posted much earlier in this thread, I am THANKFUL that we have an IV team at our hospital. At the previous hospital where I worked med-surg, we had to try two IV sticks before asking for help. With more and more patients who are elderly, or chemo patients with poor veins, or mastectomy patients with only one useable arm, if I missed my two attempts, I just lost two potential sites and caused the patient pain from my sticks twice. Because of working part-time, I might only have had to restart an IV twice a month. How was I ever to become proficient that way? The EXPERTS-- the IV nurses-- are better for the patients, and help us to do OUR jobs better.

nurseluv9 · Feb 20, 2004

I am so impressed by the sharing of ideas here in this thread.That inspires me to learn how to insert IV.Im planning to practice my profession soon as soon as i pass my exam.I just wanna ask if theres a school offering IV therapy or class that i can attend to for short period of time like month?thank you so much in advance and God Bless all the nurses!!!

moia · Mar 9, 2004

well I am going to let you all in on a little secret. The IV team is a godsend.

It is where we can go when we break down. When our back injury prevents bedside nursing we still thank god have the option of IV services. I can still care for patients but I can also stay relatively healthy and I get paid!!!

The IV services team I am joining has some pretty big responsibilitys, we now start PICC lines and work with Hickmanns and portacaths and we look after the chemo population who have almost no veins left and save the floor nurse the agony of an hour looking desperately for a vein. I know sometimes it looks like IV services does nothing but in my hospital one IV nurse does over 60 sticks a day. All the same day surgery and eye clinic patients need an IV and the nurses are usually pretty overwhelmed with the ridiculous amount of paper work just to get a patient admitted.

In fact I have now made myself really nervous and I am an open heart nurse, who would of thought that the thought of starting 60 IVs is worse than a 12 hour code?

stevierae · May 12, 2004

Since our hospital switched to the retractable-needle IV cannula, we've all had to re-learn technique. The rep (HAHAHAHAHA - almost wrote REPTILE!) assured us these needles were sharper, "much sharper than those you've been using." While I wholeheartedly appreciate the protection value of our retractable, the rep's statements translated to: "You won't feel the POP anymore when you hit the vein." As Radiology Nurses, we start 20+ IVs a day in CT, most "first time, every time"- EXCEPT after we switched IV needles! We found ourselves doing in two and three tries what we'd previously done in one. FRUSTRATING for us AND our pts. It was SO HARD to start the IVs without feeling that POP! We even had the rep come out to critique our technique (and we certainly verbalized our dissatisfaction w/product -- too late, contract already signed, etc.) and offer suggestions: What are we doing wrong???? We did improve but it took 2 - 3 months till I noticed improvement for myself. Anyone else have any stories about same?? ;)

I had previously posted this on another thread, but had to comment when I saw this! By the way, the people that teach this IV catheter are not reps--or REPTILES, LOL!! Although the reps are often there, the people hired to TEACH the product are RNs. I take a great deal of pride in knowing that, at least at the facilities where I have taught, the staff becomes fully competent and really likes the product, and they use it correctly.

I used to teach this IV catheter, which is called an InSyte AutoGuard, made by BD. One can "blow" the vein with the stylet upon cannulation; that is why we teach new users to go in "low and slow."

Here are a couple of tricks to avoid blowing the vein, that you may or may not have been taught:

---Before you start, hold onto the catheter hub where it attaches to the clear flash chamber (just above the button.) You will see a slight notch there. BE CAREFUL NOT TO PRESS THE BUTTON!!!

---With the opposite hand, grasp the clear flash chamber at its base, and twist it--NOT THE CATHETER ITSELF-- to the right, a full circle, (360 degrees) until you hear a slight "click." You have brought it all the way back where you started, to that "notch." (The notch is just above the button; again, be careful not to press the button.)

We taught this step by saying "take it for a spin. " This action will loosen the heat seal between the catheter and the stylet, and allow the catheter to "glide" off the stylet easier. If you neglect this step, the catheter may feel "sticky" when you attempt to advance it off the stylet, and may cause you to inadvertently "blow" the vein when you struggle with it.

---Here is the most important step: Remember, your approach should be LOW AND SLOW.

---Place your thumb and index finger on the little "grooves" on the side of the flash chamber (created for that very reason.)

---Angle the catheter, bevel up, at approximately 15 to 30 degrees above the skin.

---Stick, (just enough to get the catheter tip in) stop, lower the catheter almost flush with the skin.

---As IAG's stylet is sharper than some of the other brands, and thus cannulation less traumatic, you will not feel a POP as you enter the vein as you do with some other brands--that "pop" with other brands is trauma to the vein from a stylet that is not sharp enough.

---It may take a bit longer than some other brands to see the flash in the chamber--but if you have successfully accessed the vein, it will appear. Be patient.

---Now ADVANCE THE ENTIRE UNIT--not just the catheter--approximately 1/8".

---This is important with ANY IV catheter, to make sure a good portion of the actual catheter is in the vein--not just the tip of the stylet.

---Go ahead and thread your catheter off the stylet.

---Push the button, stabilize your catheter, put digital pressure above your tourniquet, (this will cut down on "back-bleeding") and pull your tourniquet. ----Dress IV site according to institutional policy.

FYI: the 22s and 24s have a "divet" cut into the tip of the stylet, which allow you to see a drop of blood IN THE CATHETER before you see it as a flashback in the chamber.

Another FYI: One of the most common reasons for the complaint of "I got a flash, but the catheter won't thread" is failure to advance the entire unit another 1/8" into the vein before threading the catheter off the stylet--it means that only the tip of the stylet is in the vein, and not the tip of catheter itself.

I have taught other brands of IV catheters, but I have always liked the BD product--even before the safety button; back when it was simply called an InSyte--because it is SHARP.

Here is my frustration with teaching IV products, and especially in hospitals that have IV teams: A lot of RNs simply do not want to learn.

I cannot tell you how many times I have gone to various med-surg units nationwide to have RNs--and this is RNs with 30 years of experience--say to me, with pride, "I have never started an IV in my life, and I don't intend to start now. Before we had IV teams, I would call the house supervisor or anesthesia. It's not my job. Oh, did you bring any candy?"

When I learned to start IVs, I was a Vietnam era corpsman, and even when I went to nursing school in the early '80s, starting IVs was considered basic patient care. It is an incredibly easy skill to learn, and one does not have to do it every single day to remain proficient. In fact, I take travel assignments these days, often one every two years--but it's not like one gets "rusty" or can't get right back into the swing of things after starting 2 or 3.

I think IV teams are really great to have for PICC insertions--then again, a lot of hospitals have gone to doing those in interventional radiology--but I think that simple peripheral IV access should be considered a basic nursing skill.

FYI, at most places where I have taught, the radiology nurses and techs--IR, CT, MRI, nuclear medicine etc--are really receptive to learning, and are really good at IV access. Some of the med surg nurses I have encountered could sure take a lesson from them--especially in attitude!

stevierae · May 12, 2004

Well in my opinion two sticks hurt more than one. And many times lidocaine doesn't numb the area sufficiently.. I think using lidocaine is lazy because you just want to "stick" someone arbitarily. Have you ever had lidocaine injected into you?? It burns like fire water. And it hurts.. And I think a 30 guage needle hurts more than an 18..
In my opinion using lidocaine is a short cut for someone unable to start an IV without inflicting pain.. I use 15's now with out lidocaine on a daily basis.
ESRD..

I always use buffered Lidocaine intradermally, with a 30 g needle, as yoga described. I often work in CA. You are simply making an intradermal wheal with less than 0.3 cc of fluid--far less traumatic than getting a PPD! The tip of the 30 g needle is all that is under the dermis, and just BARELY, at that. I have never had a problem with "numbing the area sufficiently."

When I work in Oregon, some hospitals do not allow their RNs to give 1% intradermal Xylocaine for IV access--God knows why. However, some do allow 0.5 % intradermal Xylocaine, (supposedly does not burn as much) OR they suggest making a wheal with injectable NS. I am skeptical as to why the NS technique would work, but there are those who say it does.

IamRN · Jun 3, 2004

Also no use for respiratory techs, nurses are qualified to do the same things, minus vents, and we have a holistic view of the patient and can prioritize based on that- plus we are used to working together. Where I work the RT's are trying to get nurses to take over their duties for the night shift- including vents. If we are good enough when they don't want to be woken up why not transfer their budget to us and let us cover the whole day.

Careful what you ask for! The RT work may be coming our way sooner than we think, w/o the extra compensation of their budget influx!

nadia562002 · Sep 5, 2004

My hospital recently decided to have a back-up IV nurse in place for when the bedside nurse was unsuccessful. I believe it is a dis-service to the nurse to not be allowed to place an IV because a IV team is there to do it. A good nurse should have this skill and at the least be proficient at it.

jnette, ASN, EMT-I · Sep 5, 2004

When I learned to start IVs, I was a Vietnam era corpsman, and even when I went to nursing school in the early '80s, starting IVs was considered basic patient care. It is an incredibly easy skill to learn, and one does not have to do it every single day to remain proficient. In fact, I take travel assignments these days, often one every two years--but it's not like one gets "rusty" or can't get right back into the swing of things after starting 2 or 3.
I think IV teams are really great to have for PICC insertions--
--but I think that simple peripheral IV access should be considered a basic nursing skill.

Couldn't agree more. I, too learned IVs as a corpsman (same era)... and have always just assumed that it was considered a basic nursing skill. Have been quite shocked over the past few years to read that this is no longer so? I can't imagine being a nurse and never starting (or wanting to start) IVs... just can't imagine that. Truly.

nurseunderwater · Sep 6, 2004

oh cr*p

nevermind.

RN-PA, RN · Sep 15, 2004

Couldn't agree more. I, too learned IVs as a corpsman (same era)... and have always just assumed that it was considered a basic nursing skill. Have been quite shocked over the past few years to read that this is no longer so? I can't imagine being a nurse and never starting (or wanting to start) IVs... just can't imagine that. Truly.

I know you worked on a med-surg floor for a while, jnette, so you have some idea of the numerous tasks and burdens already placed on med-surg nurses, and as I said in my previous post above:

That's a great concept in an ideal nursing world, but with nurse-to-patient ratios on med-surg of 1:6-7, PLUS higher acuity patients, PLUS covering LPNs' patients, PLUS computer documentation, PLUS many nurses working part-time, becoming proficient at IV starts can be unrealistic for many of us.
As I posted much earlier in this thread, I am THANKFUL that we have an IV team at our hospital. At the previous hospital where I worked med-surg, we had to try two IV sticks before asking for help. With more and more patients who are elderly, or chemo patients with poor veins, or mastectomy patients with only one useable arm, if I missed my two attempts, I just lost two potential sites and caused the patient pain from my sticks twice. Because of working part-time, I might only have had to restart an IV twice a month. How was I ever to become proficient that way? The EXPERTS-- the IV nurses-- are better for the patients, and help us to do OUR jobs better.

I would LOVE to have the time and proficiency that comes from starting numerous IV's, but it's not possible OR realistic with the ratios, acuity, working part-time, and other demands placed upon us.

mattsmom81 · Sep 16, 2004

I've always started IV's but have run into quite a few nurses who came from big hospitals with IV teams where they were not given the opportunity to learn. Many never had the chance to start one in school either, except on that rubber arm...LOL!

Funny how everything has a specialty these days, eh? I sure wouldn't mind starting IVs all day ...(on beds that raise up) ...to get away from the lifting.