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orders for IV access

Hi Everyone,

I have a concern that where I work there is often No seperate order for IV's. For example cardiac patient who get admitted and where a telemetry monitor should have IV access. Its like a nursing order. When I inquire the floor nurses state he has telemetry therefore he needs IV access.  We get index cards with the  floor nurses request for HL or SL.

Another example is when IVPB antibiotics are ordered does that cover me who just goes around and inserts IV access for floor nurses?

Transfuse 2 Units PRBC. Clearly you need an IV to transfuse but Im not the one administering the blood, Im the one inserting the line.

  I prefer to  have a seperate order that would say insert IV saline lock or something. I have been doing a lot of reading and legally I know there should be an order to cover me. I work at a Veterans Hospital so some things are different than private sectors, but I still feel as though I should have an order before I go do an invasive procedure even if it is only IV insertions. Am I correct in wanting a seperate order or am I just making a fuss?



In some of the cases you

In some of the cases you mentioned, I think you are overthinking it, but in another one, maybe not. When you have an order to give any type of IV fluids, medications, blood, etc. I do not think it is necessary to have a separate physician order for the IV catheter. Clearly, the nurse inserting the catheter is the one making the decisions about the catheter size and its location and you must have some type of catheter to accomplish the infusion. In fact, I teach a class about how to do an assessment of the vascular access needs of each patient and how to choose the most appropriate device. I strongly believe that this is nursing's domain and not the physicians role. We know the charactertistics of the catheters, the therapies, and the patients needs much better than any other professional.

There could be an issue when you do not have an order to give any IV fluids or meds and they wish to maintain some type of peripheral venous access - usually a just in case thought process. In those situations, I think you would need some type of order. For instance in telemetry, if you have standing orders to give X drug if Y happens, then that is enough for me to insert a catheter.

 The problem comes when there are no orders of any kind and a catheter is allowed to remain in place and is forgotten about or the nurses think they need an order to remove it. This may be a situation where EMS placed the line but there were no IV orders upon admission. I think it is nursing's role to get that catheter out ASAP. 

So, the bottom line is that I do not think you need a specific order to place a short peripheral catheter when there is any type of fluid or med prescribed. When nothing is prescribed, you need to have a hospital policy to guide your practice which could specifiy the need for an order. Lynn 


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Robbin George
There are standing orders in
There are standing orders in our facility that any patient on Telemetry must have at least one functional SL in place at all times--Makes sense when there is a slightly higher potential for a Rapid Response or M-Set in this population

Robbin George RN VA-BC

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