I work in a small vascular access group, placing PICC lines and "hard sticks." Of the four people in our group, 2 have more than 30 years experience as "IV team RN's." The 30 year RN's will often place what I consider an inappropriate IV instead of asking for a PICC line. In the last few weeks, IV's have been placed in: the index finger, the "pinky" finger, the foot, and the region of the upper chest in superficial veins below the clavicle. The staff nurses use these lines for just about any medication including vessicants. When I ask a staff nurse if they are comfortable with using the line, the typical response is, "It's all I've got to use." The 30 year RN's see no problem with placing lines in these areas. I don't do this, I either ask for a PICC order or I use our ultrasound machine to place what I believe is a more appropriate line. Our PICC numbers have been lower than what is expected for a hospital our size. One of the 30 year RN's said this is because "we are so good" at placing peripheral lines. Is there anyone who routinely places IVs in fingers etc. when no hand or forearm vein is visible or palpable?
Wow... What a challenge you have. To get these "older" IV nurses to see the error of their ways will be challenging. However, Placing an IV catheter in the "pinkey" or other digits should be strickly a LAST RESORT and really is unacceptable, imo, in today's environment given the fact that US is available.
I would only cannulate those finger veins if my US was broke, and it was truly a last ditch effort to gain access to their venous system, and I was infusing an isotonic solution without additives.
As far as cannulating the superficial vessels in the chest, or breast tissue.... JUST SAY NO! As a Vascular Access Nurse, one must question, why they are there, when normally they aren't!.
To access them just becuase they are present isn't wise on these "older IV nurses" part. Isn't best practice to follow INS standards? Are these nurses CRNI's?
This sounds like egos are involved. The question is not CAN you be successful with inserting a small short peripheral IV catheter into a digital vein. With very good technique and a high level of skill, it is relatively easy to do. 20 to 30 years ago, IV infusion nurses had no other options in many patients. The question is SHOULD we still be doing this and the answer is a resounding NO. In your situation, I would track these sites to see how long they dwelled successfuly. Use your own data to show that they fail after a short period. Look at the number of sticks the patient must endure. Look at the cost of doing this repeatedly. Look at patient safety issues in the events of infiltration or extravasation in these sites. If this data is not adequate to convince these very experienced IV nurses, then it might take a written policy and a strong supervisior to enforce it. There are now better method to locate larger veins in the forearm where the catheter will last longer with less risk to the patient and we need to advance our practice with this technology. 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
wow, I am speechless. Kudos to you for recognizing that these are innappropriate placements and best of luck on getting them to change their habits. I read a comment on Facebook today that fits this scenario, "The most dangerous phrase in the language is "we've always done it this way"
i say well done you, you are right these nurses with 30 years experience require updating in vessel health and preservation- VHP Is there a manager you can talk to these nurses need education and to stop cannulating inappropriate veins. You are doing a good job keeping your patients safe.
vipvenepunctureandcannulation.co.uk
Ive tried to not comment lately because everyone gets upset with me. But, I have to here. I will say again, peripheral IV's should be gone. OK so now let me back off . PIV's have a limited place in daily practice. The catheters that we are all used to, have now worn out their welcome. That's why companies like Bard, Angio...are going to a longer, more vein friendly catheter. It's the same story. 60% of the population is either overweight or obese. Me included. But that presents for more difficult access. So, now everyone is trying to use US guidance without being US competent. Or, worse , we are going into the tributary veins across the chest ,shoulder...or fingers. It's just ridiculous the way we will "hurt" patients and use the "I had to get something" as our excuse. There is NO excuse. This is 2016 and given today's technology and the advent of Vascular Access specialist, patients should DEMAND better. If for any reason, because we don't demand it for ourselves.