INS states that the maximum number of attempts at venipuncture in situations that are not life threatening is two. I am wondering if there are facilities that follow this guideline. What happens after the 2nd attempt? What defines life threatening? A dehydrated 92 year old may be hard to access in two sticks only but is it life threatening? Are there any other proffesional orginizations that follow the recommendation of two sticks only for PIV. Just wondering what the rest of IV world does?
Our hospital does adhere to this policy but it is 2 sticks per nurse. Most nurses will not try a second time if they do not see anything to stick, they will call in someone else.
Educator at rural hospital
After 2-3 tries, I will ask other IV expert inserters to try ie anesthesiologist, float nurse, or PICC RN using ultrasound machine, etc. With an ultasound, PICC RN should be able to see an antecubital vein.
To alleviate pt's discomfort, we always offer to numb their IV site using bacteriostatic saline. Most often patients don't mind us trying a few times to insert their IV since they were numbed up.
If all else fail, time to think about a PICC line!
Good luck,
Jean
Usually most of us will try 2 times, sometimes though not more than one and sometimes more than two. I think all of us at the chemotherapy day unit (all rather good at placing PIVs) feel that we do not lose face (correct English?) asking a collegue - rather the opposite that is proffessional to leave it to someone else when you feel too unsure of succeeding at another try. We all have bad days or just a bad moment, so I try to trust how I feel about trying once more in each case. We do not have a strict rule, though. We will also use ultrasound sometimes to place a PIV, well aware of the risk of placing a short PIV in a too deeply lying vein. Certainly placing a CVAD should be considered in many cases, even if it is not always the right choice or if it cannot be done stat.
Mats in Stockholm
The original message is a misunderstanding of the INS standard statement. In Standard 42 Catheter Placement, Practice Criteria I states, "No more than two attempts at cannulation by any one nurse should be made in order to avoid multiple unsuccessful attempts, causing unnecessary trauma to the patient and limiting future vascular access." This means that 1 nurse should only make 2 attempts. It does not say anything about the total number of nurses or attempts that should be done. This statement does not say anything about life threatening situations. Each patient situation is quite different. It is these situations that drive the demand for infusion nurse specialists with venipuncture skills at a higher level than a primary care nurse and also have the skills to use technology such as US or infrared devices to locate difficult peripheral veins. If the situation will require therapy for a few days or weeks, a peripheral catheter may not even be the best choice and this can also be determined by an infusion nurse specialist. 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