Currently we are looking into frequent PIV attempts on our patients. Curious to know what policies & procedures are followed by other facilities. We have up to 4 PIV attempts (2 per nurse), then call the vascular access team or more experienced person for help.
Does your facility have a IV team in addition to PICC team? Do you have a IV or vascular access assessor at time of admission?
I have seen many hospitals with policies for the primary care staff to make XX of attempts before calling the infusion nurse. I think this policy is counterproductive and only serves to waste the peripheral veins that the infusion nurse probably had a good chance to cannulate. But I know this is the thinking for most hospitals. I think we need a tool that no one has created yet. It would be a method of pairing the patient and their level of difficult veins to the skill level of the inserter. For instance, a grade of 1 would have such good veins that a student learning venipuncture could be allowed to try. On the opposite end, grade 5 would have such few peripheral sites, bad skin turgor, dehydration, etc, that the infusion nurse is the only one allowed to make an attempt. I have never seen such a tool yet, but I keep hoping. I have had a legal case where this was an issue. Policy was 6 attempts before calling the infusion team but the infusion team left at 7 pm. By the time the 6 were tried, it was after 7 pm, no infusion nurse to call. Patient requested that they keep trying. Finally got a vein in the volar (palm side) of the wrist which extravasated requiring fasciotomy and carpal tunnel release. I am not a fan of these policies. 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
Lynn,
Thank you for your information, it was literally inspiring. I have sat down and started developing a assessement tool (Assessment score for patients and a Nurse Skill Level) which is in the rough draft but my manager loves the idea. I feel that too many times the wrong skilled nurse is attempting the patient with challenging veins just because the nurse is the primary care giver for the shift and she literally takes a stab at trying to get access that is way over her skill level. My goal is to create a per floor skill assessment of the nurses and give each patient a IV Access "score"based on intiial admission assessment of the patient's veins or lack of, that would be shown on the electronic record, on the top information including the name and allergies. This would than alert nurses how difficult a patient is in IV access, and have only the nurses who have that skill level or high try this patient.
Right now, I am trying to work on keeping it simple in vein description and scoring of patients and the other side is ranking the skill level of the nurses. If you have any feedback I would really appreciate this.
Thank You,
Tracy
Tracy W. Ivory, RN, BSN, CRNI, VA-BC
Faxton-St. Lukes Healthcare
Wonderful! Please consider publishing your ideas. I would also keep it simple such as 3 or 5 levels of patient characteristics including visible sites without a tourniquet, visible sites with a tourniquet, palpable sites only, quality of skin turgor, patient's diagnoses focusing on dehydration or fluid volume deficits, history of infusion therapy, the prescribed therapy. Hope this is helpful. 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
Thank you Lynn for your feedback. I agree with keeping patient veins assessments simple and no more than 5 levels. To make this usable I want some easy to use and not too time consuming. Will keep people up dated as we move forward.
Tracy W. Ivory, RN, BSN, CRNI, VA-BC
Faxton-St. Lukes Healthcare
Lynn,
I think your assessment tool is a great idea especially if it could be incorporated with diagrams or pictures of what such veins might look like. Thanks for the suggestion. I will discuss that idea with my associates to see if we could work on something similar for use at our facility. I was horrified to get a call to the floor for a patient that had been "stuck" 15 times before a cardiac cath before they stopped and just sent the patient to the floor with his venous and arterial sheath in place for me to get an IV in. I was available all day and am not sure why I didn't get called pre procedure as I had no PICCs that day that I was tied up for a long time with.
Mary Penn RN
St Charles, MO