An order for infusion therapy - fluids, medications, nutrition, blood, by the IV route - is sufficient to indicate a need for some type of vascular access. There should be some type of assessment of vascular access needs, either by the primary care nurse or the infusion nurse but someone should be looking at all the related factors. You may choose to begin infusion through a short peripheral catheter and put in a more appropriate catheter later. I have never practiced where there was a need for a specific order stating to insert a short peripheral catheter. And I strongly believe that guage size and site is strictly a judgment by the person inserting the catheter and should not be prescribed by the LIP in the written prescription. Lynn
The only time as an IV therapist I've ever asked for an order from an MD is when a nurse feels a patent needs to have a PIV "just in case." The setting was the issue. In the ICU unit, P&P allowed for that. On the "tele" floor, it was also written as policy. In the ER, policy also protected me. On the regular med/surg floor however, in the absence of an emergent situation, I ALWAYS requested an order from an MD. Inserting a peripheral catheter is an invasive procedure. There is a risk of either temporary or permanent injury. And that's not even addressing the issue that the staff will be "pushing" saline (which can be considered a medication by some state boards) & or heparin (which IS a medication) to keep the catheter patent. As Lynn stated, an order for ATB or IVF'S, etc. imply that a peripheral catheter needs to be inserted. When that implied order is not present (the "just in case" scenario), no policy is in place, and no therapy has been ordered, I feel an order should be obtained. I also feel that a nurse who is inserting a peripheral catheter "just in case" without consulting a physician could be viewed by the state board as being outside his/her scope of practice. Am I splitting hairs in today's litigious society? I don't think so, as if the patent does becomes injured, a good lawyer would have a field day as an "unnecessary" and "unauthorized" invasive procedure was perfomed.
As nurses, we have all felt a patient "needs" something "just in case." There are things we can do in preparation of the "just in case" scenario as dictated by our prospective state nursing boards. One of those things would be calling the MD, give your assessment of the situation, and let the MD make the call as to wether or not a PIV is appropriate for the "just in case."
Our policies cover the insertion of a short PIV. As Lynn states, if IV meds, solutions, fluids are ordered our policy states that a separate order is not required. Our policy states if a patient is on telemetry a peripheral IV is required. A physician may order an IV, often anesthesia will order an 18 or 20 gauge but that may not be what they get given the patient's vascular status.
An order for infusion therapy - fluids, medications, nutrition, blood, by the IV route - is sufficient to indicate a need for some type of vascular access. There should be some type of assessment of vascular access needs, either by the primary care nurse or the infusion nurse but someone should be looking at all the related factors. You may choose to begin infusion through a short peripheral catheter and put in a more appropriate catheter later. I have never practiced where there was a need for a specific order stating to insert a short peripheral catheter. And I strongly believe that guage size and site is strictly a judgment by the person inserting the catheter and should not be prescribed by the LIP in the written prescription. 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
The only time as an IV therapist I've ever asked for an order from an MD is when a nurse feels a patent needs to have a PIV "just in case." The setting was the issue. In the ICU unit, P&P allowed for that. On the "tele" floor, it was also written as policy. In the ER, policy also protected me. On the regular med/surg floor however, in the absence of an emergent situation, I ALWAYS requested an order from an MD. Inserting a peripheral catheter is an invasive procedure. There is a risk of either temporary or permanent injury. And that's not even addressing the issue that the staff will be "pushing" saline (which can be considered a medication by some state boards) & or heparin (which IS a medication) to keep the catheter patent. As Lynn stated, an order for ATB or IVF'S, etc. imply that a peripheral catheter needs to be inserted. When that implied order is not present (the "just in case" scenario), no policy is in place, and no therapy has been ordered, I feel an order should be obtained. I also feel that a nurse who is inserting a peripheral catheter "just in case" without consulting a physician could be viewed by the state board as being outside his/her scope of practice. Am I splitting hairs in today's litigious society? I don't think so, as if the patent does becomes injured, a good lawyer would have a field day as an "unnecessary" and "unauthorized" invasive procedure was perfomed.
As nurses, we have all felt a patient "needs" something "just in case." There are things we can do in preparation of the "just in case" scenario as dictated by our prospective state nursing boards. One of those things would be calling the MD, give your assessment of the situation, and let the MD make the call as to wether or not a PIV is appropriate for the "just in case."
IV GUY
Our policies cover the insertion of a short PIV. As Lynn states, if IV meds, solutions, fluids are ordered our policy states that a separate order is not required. Our policy states if a patient is on telemetry a peripheral IV is required. A physician may order an IV, often anesthesia will order an 18 or 20 gauge but that may not be what they get given the patient's vascular status.