Forum topic

5 posts / 0 new
Last post
ebaxter6
Difficult Peripheral IVs

My question is how do other institutions handle peripheral iv insertions on difficult iv patients?

We are a university setting (379 beds), patients are sent to our institution after being treated days to weeks at other institutions both inside and outside the state and country, depleting the patients vascular access.  We do not have an "IV team" at our institution.  The current practice for iv insertion is with the bedside nurse, if he/she is unable to place the peripheral iv, then he/she consults with the "expert" on the unit, if that person is unable to place, then a call to the picc team or line care team who has access to ultrasound placement for peripheral iv is contacted.  Since piv placement is not the primary responsibility of either of those teams, and at times both teams are unable to respond, the nurse and the patient is left unable to administer the iv medication, and the md is consulted to see if a central line can be placed or some one from another unit, CT, ER or ICU may be contacted.

We have been told we cannot have an "iv team". So that is not a possible answer. The institution is currently looking at the accuvein to assist the nurse in iv placement.  However, I know from placing pivs on these patients with ultrasound, the patient just doesnt' have the veins to access.  The doctors give the typical statement of the patient is just going to be here another day or two, so they don't want to place a central line.

Any suggestions on a creative solution, would be greatly appreciated.  I feel very bad for our pateints.

Thanks,

Beth

 

lynncrni
They have to have a reason

They have to have a reason for the position on "no IV team". What is that reason? When the lack of skill is the problem, the only answer is to improve the skill level. If they still wish to leave this in the hands of the already overburdened staff nurses, then there must be significant investment in knowledge and skill development. All technology such as infrared light and ultrasound devices will require an advanced level of skill also. So they are not an immediate answer either. The only answer is to expand the services of the existing teams to meet the needs of these patients. I strongly suspect that if someone made a thorough assessment of the situation there would be many other problems found that could be improved by a full service infusion therapy team. That is my focus this year. I have a new presentation on this topic and will be chairing a new INS committee on this very issue. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

DEVON1
My hope is that the Joint

My hope is that the Joint Commission or IHI will step in one DAY and hold the health care institutions accountable for establishing proficency in PIV insertions. Until this problem that nurses and pateints have to deal with reaches the top organizations nurses do not have a chance. I'm not sure why INS,AVA, LITE, ONA are NOT able to step-up to the plate when it comes to these issues, I wish their voices were alittle bit louder by approaching the Joint Commission or IHI to demand that INFUSION NURSING BE TAKEN AS A NURSING DISCIPLINE and stress the need for implementing IV/PICC teams as a NATIONAL STANDARD!!!!  We can attend the confererences, pay for the high price memberships, take the certification exams, READ THE journal, blogs and support all the Infusion experts in the field this is all fine, but when we are at the bedside at 3am without IV access and the patient has missed medications all the organizations, memberships, journals, blogs, certifications can not implant and a viable vessel for that patient. Until all the organizations work together and realize that patients are receiving more complex IV therapies that have placed them in a state of VENOUS DEPLETION, IV TEAMS AND PICC TEAMS WILL CONTINUE TO BE DEPLETED ALSO.   The insertion of a PIV is a minimally invasive procedure with associated long term complications these hospital administrators just do not understand BUT are national organizations DO understand the need for IV Teams and PICC Teams and SHOULD MAYBE ONE YEAR INSTEAD OF HAVING THESE EXPENSIVE CONFERENCES group together with all the IV experts, speakers, and board members tour the major hosptials around the US and promote IV/PICC teams. These teams in the long run are SO VALUABLE!!!!        

Jane L.
I agree having been on an

I agree having been on an IV team and now the hopital I work at has turned the team into a PICC team and taken peripheral IV starts out of our hands unless we are available and not inserting a PICC.  The CDC back in August 9, 2002 they stated "IV-therapy personnel.  Designate trained personnel for the insertion and maintenance of intravascular catheters."  It is a Category 1A. Why are we not following this?  IHI  and the TJC should follow there safety rules.  Goal 7 states - reduce risk of health care associated infection. Goal 15- the hospital identifies safety risks inherent in its patient population.  This really is a sad situation for all.  The patient gets the brunt of this.

Kathleen M. Wilson
Wow, your story sent me on an

Wow, your story sent me on an IV team reverie. We have about 40 beds. I work in a procedure center, which does everything, but ebbs and flows with the "IV team." About 2 to 3 years ago, the mgmt agreed to the idea of having us be the IV team. This included the idea of being the go-to, picc insertions, infusion clinic, and monitoring of in-house intravenous lines. We started doing daily rounds on ALL lines in the hospital. This all was set up informally, I say this because there is no policy about this, no extra staffing, no reimbursement. We tried to not take over everybody's IV skills, but be a resource and help with compliance. We would round, and document how the IV looked. We would tell the primary nurse if it needed changed, ie the date was expired, the drsg wasn't intact, it looked infected, etc etc. In that day, we were the only ones to be able to do PICC drsg changes, so we included that on our rounds. It gave us a chance to advocate for different access, depending on what we could see the patient was getting. I have to say it drummed up some (appropriate) PICC business. All good. One of the first things I remember happening was that the primary nurses got upset that we told them stuff about their IVs, and then we had to tell the director , who told their director, who told the nurse. Then, I remember with some staff changes, we couldn't always get our work done, and then get all those rounds done every day. The next thing that hit was the economy downturn. We lost 35 FTE over a year ago. The IV rounds went away, just kinda slowly and sadly, but we did not have staff to send off our department and take care of our pts on the schedule.

Here's what happens now. Its like your place. They call us (and like you experience, sometimes there is a delay in our availability).  We take the U/S but always look without the U/S first. A lot of times, you don't need it if you know how to look for veins. We get called everywhere, sometimes after they've tried a lot, and sometimes before they'll try at all. The staff is always so grateful, and they'll say things like "There's no way I could ever have found that vein.." If you ready Lynn Hadaway's article "Development of an Infusion Alliance" (JIN, 2010, 33(5), 278-290) the introduction talks about how the technology (complex)  and ecomony have impacted deficits in nurses' training re: infusion therapy (the whole article is great).  I feel this in our facility re: IVs. They don't get a ton of training in school, and really not a ton on the floors if you think about it compared to an ED or an infusion clinic or day surgery.

 

Here are some solutions for you to contemplate:

1. There is a lot published about the cost-effectiveness of IV teams. Money talks. Maybe they said NO IV team because they are lacking proper information.

2. See if your education department can sponsor an IV or infusion class.

3. Consider ways to empower your nurses with their IV skills. Maybe when you go down to start that difficult IV, you could ask the primary nurse to come in with you. Teach him or her while you are doing it.

4. Read up on IO and present it to your governing body.

Good luck!

 

Kathleen Wilson, CRNI

Log in or register to post comments