Forum topic

Yes, we document unsuccessful PIV attempts. We put it in the notes. Its pretty quick and simple, but important to write down what was done for the pt, and also demonstrates need for different type of access if it comes to that. We also document if U/S guided placement was used.

I don't believe we are successful in documenting this at all.  The importance has not been stressed enough to staff.  Their focus is all about the successful IV insertions and continuing medications.

Currently, we don't even have a way to measure 40% or any percent.........

Sad.

What was the driving force 8 months ago to have this required?  I am not questioning that is needed, BTW.

Gwen Irwin

Austin, Texas 

I would love to hear what a nurse attorny or legal nurse consultant has to say about this subject.  I have always been lead to believe you must document all that you did and I do document unsuccessful PIV attempts in order to show that there my be a need for a central line etc.  Valorie

The problem is not with the Vascular Access professional's documentation of unsuccessful PIV attempts [You should also be documenting # venipuctures to insert PICC]

The PROBLEM is ALL the "People" [skilled and unskilled] who "Stick" the patient prior to the Vascular Access professional's initial and subsequent contacts with the patient

Literally DOZENS of attempts go undocumented--We do not have professionally trained techs drawing our Labs--So PIVs and phlebotomy are done by staff RNs and floor techs

AND what about the patient's venipuncture experineces in an emergency environment [Ambulance and ED before they even get to the floor, or in a Code situation] 

Even if your policy states the "2 attempts/person" rule it probably does not limit how many Persons can attempt

The peripheral venous condition of some of the patients we see these days brings tears to our eyes

Robbin George RN Vascular Access Resource Department Alexandria Hospital Virginia

I believe these experiences are nationwide.  As an educator and a vascular access nurse I teach that placing or attempting to place any line is an invasive procedure and all attempts must be documented.  With that said, this compliance is hit and miss, most often "missing".  Unfortunately, the only way this will get the attention it needs is through the legal system when patients suffer injury and are awarded compensation.

I agree that this situation exists nationwide.  I think it's important to empower both the patient and the nurse.  The patient (or his representative,i. e. parents of minors)  must be able to say enough.  More importantly I believe the nurse must be empowered to say no when confronted with a challenging patient in whom many attempts have already failed.  When physicians instruct nurses to place an IV regardless of the cost, nurses feel compelled and "ordered" to do exactly that.  I have often told the staff here that they can say no if in their assessment it is a futile endeavor resulting in significant physical and emotional trauma to the patient (and the nurse as well).  Often, when an IV is obtained it is a short term solution for a long term problem and when that IV goes (usually in 24 hours or less) the very same situation exists again. We are a teaching facility and I instruct the nurses to tell the residents that they no longer feel comfortable attempting yet again to place the impossible or short lived PIV but that they will have the supplies at the bedside and be happy to assist the MD in that endeavor.  Usually this will cause the MD to look at alternate solutions.

Nevertheless, this scenario happens much too often.

Someone asked for the opinion of a legal nurse consultant on this thread. While I am not a legal nurse consultant, I am a testifying expert witness on many cases involving all types of IV catheters. Actually it is the testifying expert that would have more knowledge of these problems than an LNC as LNCs work behind the scenes and do not testify as to the details of the case. I have reviewed ~150 to 160 cases, most of them involving short peripheral catheters and infiltration or extravasation injury. Outcomes are compartment syndrome, necrotic ulcers - both requiring surgical intervention - and complex regional pain syndrome, a lifelong severe pain problem. One of the most significant problems is multiple venipuncture attempts. There is rarely any mention of the actual sites of these attempts. So when I review the records I have no way to know if the final and successful site was below any of these attempts or not. When there is fluid/meds leaking into the subq tissue, this leakage can easily come from these previous puncture sites. Read my chapter on Anatomy and Physiology in the INS testbook for a description of wound healing. These attempted sites can easily damage the vein above the final infusion site and produce this leakage because there has not been time for healing to occur. If these sites were documented, it would go a long way to protect the nurse and support their practice decisions. Without that information, the expert is left without any information on what actually occurred. The old adage of "If it was not charted, it was not done" remains in effect. If we can not determine that the final site was above the other attempted sites, then the expert can not say with any degree of nursing certainty that it was below the damaged sites, producing a great risk for the fluid leakage into the SC tissue. So that is what an expert would be looking for when assessing a legal case. This is a critical part and we rarely have this information to support the choices made by the nurses doing these attempts. This means that the patient (plaintiff) is in a good position to win the case. This is part of what attorneys would label as a "fact pattern." So the more you can do to get this information documented, the better it will be for all nurses when it comes to any litigation. Lynn

I'll document any IV sticks in the patient chart. For reasons already mentioned in this thread. I also chart if I used US guidance.

I also keep a record for my own stats.

Mike