There has been a proposal to restrict IV attempts to 1 per nurse/2 attempts total. I think this is an admirable goal, but I am afraid it is not realistic.
What are others doing related to this issue? I know the INS standards still say 2 attempts per nurse.
There is no research on the total number of attempts for establishing 1 PIV site. I can tell you that we are creating patients with difficult peripheral venous access by the number of unsuccessful attempts being made. I gave a pressentation at AVA last year about escalation of VADs, or the unnecessary jumping from a PIV to a PICC or other CVAD when there is no true clinical indication based on type or length therapy. We are beginning to see some improvements with this problem by using infrared light devices, but still not truly strong evidence yet. I have been advocating for an assessment tool that would merge patient factors along with nursing skill factors. For instance, a patient with a high rating or very difficult veins would require that only an infusion nurse make any venipuncture attempts. Such as assessment tool does not exists yet, but I keep hoping that someone will create this. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
At my facility, we have a limit of 2 attempts per VAST Rn x2 RNs. A total of 4 attempts by our IV team before we talk to the MDs. There are situations where we will go beyond this. As Lynn said, a PICC may not be appropriate for the given situation and further attempts may be warranted.
David Dempsey MS, RN
At our facility we have a six stick maximum by nursing. Two attempts per nurse, including the vascular team. At that time no other attempts may be made by nursing unless the Vascular Team is placing a midline or PICC line. The physican may come in and attempt PIV access if they so choose or consult the ER/ICU physicans to attempt.