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holly hess
PIV attempts
Can anyone give me feedback on any guidelines they are aware of regarding limiting the number of PIV attempts to one per practitioner. I have been told this is a new CDC guideline but I have not been able to find it. I know INS states 2 attempts per person. Thanks, Holly
Ann Marie
piv attempts

Our health system policy is 2 attempts per practioner

ann marie

Agree with Lynn. Does anyone
Agree with Lynn. Does anyone have any policy regarding how many people can try before calling in the big guns? or opting for a central line?  I have had times when, by the time I get called, the patient is in tears or so upset that I have to do major damage control before I place the line. No pressure here!
Alma Kooistra
Two for us.  We follow the
Two for us.   We follow the INS guidelines.
Holly, Our institution


Our institution follows INS. However we do take into account anything the CDC recommends. I am not aware of this CDC recommendation. Which CDC publication are your referring to?

I have never seen anything
I have never seen anything from the CDC addressing this question. INS states 2 attempts per nurse, although they do not address the total number of attempts that can be made. So it is conceivable that many nurses could make 2 attempts each, meaning the patient would be stuck 4, 6, 8, etc times. I am aware of a couple of studies that reported the mean number of attempts for adults and peds as 2.18 and for peds alone the mean number was 2.35. Sad state of affairs in my opinion! Sorry for the soapbox! Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

2 per nurse and after 4

2 per nurse and after 4 attempts I place a midline. A IV start is around 25$, so after 4 times you are in a price range from a ML, try more and you have a paid PICC.


We just started a new
We just started a new policy, ours is 2 sticks per patient.  That's right, if the nurse thinks he/she can get it on the second time, fine, otherwise get help.  After two sticks they call me (the IV team).  We have a new ultrasound for inserting PICCs and we get the IV.  If it is at night, they call anesthesia.  If I can't get it or anesthesia can't get it at night, the doc has to place a central line.  We actually wrote it into policy here.  We used to have patients with bruises all up and down their arm from sticks by multiple nurses, at 2 per nurse,  but not anymore.  We've been doing this about 2 months now and have had great success.  But I also see what the problem is first, I won't just start an IV because the nurse thinks "they might be a hard stick."  If that is the case, I'll find the vein and let them do the insertion.
Laura Cook CRNI
Our policy states 2
Our policy states 2 sticks/patient. 
I like the idea of two per

I like the idea of two per patient and not two per practitioner


INS says two per practitioner, CDC gives no recommendation

That means a patient can get stuck an unlimited number of times as long as you use multiple practitioners.  Stupid recommendation in my book.  I think there has to be a stopping point.  Maybe INS should change this recommendation to two per practioner with a maximum of four atttempts and than an MD recommendation must be made.

Kathy Kokotis

Bard Access Systems

Leah Calicoat R...
Our hospital policy is 2

Our hospital policy is 2 attempts per IVRN, 4 total and then notify the MD.  We don't stick just to say we tried- if one IVRN tries once and isn't comfortable with a second attempt, she'll call a second IVRN, and if the second IVRN looks and says no, we stop there and request MD intervention. I would like to see a policy developed that mandates use of ultrasound after the first missed stick. What a concept!

Leah Calicoat, RN, CRNI, OCN, ACRN

Dan Juckette
Daniel Juckette  RN, CCRN I

Daniel Juckette  RN, CCRN

I work in a 50 bed community hospital. Doing ultrasound guided peripheral IV's is one of the ways we maintain the skills of our PICC Nurses. We allow 2 sticks in the ER and 1 on the floor before calling for ultrasound guidance. We have seen significant improvement in our patient satisfaction surveys since initiating these guidelines. It is not fair to any practitioner to be forced to de-escalate a patient who has suffered through repeated failed attempts before you even walk in the room. Additionally, notifying a PICC nurse of a difficult stick usually triggers a dialogue about what is really the appropriate access device for this patient's hospital stay.

Daniel Juckette RN, CCRN, VA-BC

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