Thursday, July 21, 2005

IV therapy escapades - part I

Things have been blessedly uneventful in the NICU lately. The census was down to 10 last weekend and the babies are all doing well. I could tell old NICU stories, but instead, I think I'll share a few of my IV therapy moments.

A long time ago, in a hospital not so very far from my home, I took a PRN position as an IV therapy nurse. That means whenever they had a need and I had a few spare hours, I'd go do some stick-and-runs, change a few central line dressings, assist with central line placements, and generally lighten the load on the regular staff so they could do things like teach people how to care for their implanted venous access devices (Ports and Hickmans, mostly) once they got to go home with them.

As you doubtless know, patients have the right to refuse pretty much any intervention - provided they're competent to make that decision.

The patient's IV had infiltrated and the staff was waiting for me to restart it. I soon found out why they hadn't tried themselves. I didn't even get a chance to introduce myself when the man announced, "If you try to stick me with needles, I'm going to hit you!" As a rule, I'd just document the refusal and go on to the next patient, but I wasn't entirely certain that this patient was competent to make that decision. I was in no mood to find out if he meant what he said about hitting so I quickly made a U-turn and found his nurse. She assured me that he had been evaluated by the psych folks, that I could legally restart the IV without his consent if necessary, and that she'd find me some help to restrain him.

The help didn't look substantial enough to keep me from getting hit - and I really prefer the cooperation of the patient in any case. When I re-entered the room, I explained that Dr. "X" really felt that he needed his IV and that I didn't care to be hit. I suggested that instead of hitting, he could share his feelings about the procedure - in whatever vocabulary suited him.

He was quite cooperative after that. He spent the next 5 minutes telling me in very colorful language exactly what he thought of the hospital and of the nurses who'd been caring for him -- and Dr. X. He didn't swing at me, though. In fact, he held his arm quite still and even thanked me before I left.


apgaRN said...

That's awesome.

As an L&D charge nurse (we start IV's all the time and are often called on to start the most difficult on our unit), I am occasionally called by another unit in the hospital to come and attempt a difficult poke (we don't have IV teams). I once spent a pleasant hour or so with a poor girl who had the opposite attitude as your gentleman friend. She knew that the IV antibiotics would help to clear her kidney infection and desperately wanted the IV access necessary to administer these drugs. I took a few attempts and called our on-call anesthesiologist, begging his help. I just knew he'd walk in and slip it in like a peice of cake. Unfortunately for her, this was not the case... I couldn't believe her patience: he tried about 15 times, including both feet, upper arms, inner wrists, and ankles... I was flabbergasted! In the end, he, too, gave up, and we decided to let her nurse explore the possibility of a central line.


The MSILF said...


For some reason in our hospital, nurses don't do IVs, only doctors and medical students. I have no idea why this is. It means they chase you around for half an hour to take care of a two minute job that they could have done alone in...well...two minutes.

I HATE IV service.

Judy said...

I can tell you why nurses don't do IV's in your hospital (and when they will). The policy is in place so med students and residents will have a chance to learn how. Nurses tend not to let med students and resident physicians have a shot at it unless they've proven themselves -- and then generally only if they can't get it themselves. After all, why waste 30 minutes tracking down a med student or resident if you can just do it yourself?

Administrators tend to think that the way around this is not to allow the nurses to start IVs. IMHO, not in the patient's best interest.

The policy in our NICU many years ago was that only the peds residents were to start IVs. This was so they would actually learn how. Since I'd come from a hospital with NO peds residents, I wasn't inclined to call the resident unless I was pretty sure they could actually get the IV started. I tended to notify them that they had restarted the IV on baby X so they could pass along on rounds that it had to be restarted (didn't want them looking stupid when the neonatologist asked).

Eventually even the neonatologists were asking me to re-start IVs and the policy changed so that the peds residents only had to start the FIRST IV.

Basically, if the nurses have any IV skills at all, they're starting some of the IVs anyway -- if they know you appreciate their efforts. If there's a way you can discretely let the nurses know that you won't make a fuss if some of those IV's just happen to start themselves, it might happen.