Hello! I am a new hospice educator with a vascular access background. Im with a hospice that sees patients in-home and in our hospice facilities. Our medical director would like our nurses to be able to place PIVs now to provide IV hydration when clinically indicated. I am currently working on the policy and protocol for this. I expressed my concern for patient safety since most of our nurses are not currently proficient in placing IVs. I believe training a small group of our nurses to be able to perform this skill and maintain competence would be safest. Can anyone recommend resources to pull from when working on this policy? I have been using the INS 2016 SOP mainly.
I asked about obtaining visualization tools, such as a vein light or ultrasound. Management is open to a vein light depending on cost, but were not open to obtaining an ultrasound. This is were I am feeling very torn. During my time as a vascular access nurse, I became very passionate about ultrasound-guided PIVs. I saw how beneficial it was to be able to provide this service to patients. My first time insertion success rate was 96% with ultrasound, which was much higher than inserting without ultrasound. Since comfort is our goal, I feel using ultrasound would be essential to prevent undue pain and complications. I also feel that we may have a high population of patients with difficult venous access due to caring for end-of-life patients. I know more training and practice is required to be able to be proficient at placing UGPIVs, and I am willing to provide that.
Am I way off base in wanting to change their minds about being able to place UGPIVs? Are there any recent studies supporting always placing ultrasound guided PIVs?
Thank you!
No, you are not off base at all. There are many resources on the INS Learning Center website. https://www.learningcenter.ins1.org/position-papers
Scroll down for a couple of position papers on the business case for teams. The 2021 INS Standards are going out for public review now and the final document will be available January 2021.
RE vein visualization. Don't be restricted to ultrasound. There are 3 types of devices availabel - visible light (much like a flashlight) and not very successful in any patient older than an infant due to thickness of arm; infrared light devices; and ultrasound. Ultrasound has the greatest learning curve. Infrared light is handsfree and is designed for superficial veins instead of deep veins which is the domain of ultrasound. For your population, I would focus on infrared light since US is too hard to learn for those without any venipuncture skills. Also, don't forget about subcutaneous infusion in this population for hydration. There is simply no need to be searching and attempting venipuncture when subcutaneous hydration works very well. See INS SOP on each of these.
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
I agree wiith your statement on subq infusions. We have always done subq infusions instead of IV. Just recently our medical director wanted to be able to provide IV infusions when clincially indicated (including weighing benefits vs risks in each pt). I am going to make sure I provide education and structure our policy in ways that will promote pt safety and reduce risk. Thank you for pointing out those resources to me. I truly appreciate it. And I cannot wait to see the new standards you all put together!