BSN with 2 IV starts??
- Thread starter ZootownMedic
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PICC insertion is basically a minor surgical procedure that must be done under surgical asepsis. The RN must be specifically trained in that procedure in order to insert the PICC. I got to see one or two put in over the past couple semesters and it was just one of those things that I just happened to be in the right place at the right time. The mechanical part of putting the PICC in doesn't appear to be that difficult, however, it is very, very important that the tip of the cath ends up in the Vena Cava and not in the Right Atria or even up one of the jugular veins. The procedure I witnessed relied heavily on ultrasound for identification of blood vessels and verification that the cath wasn't being guided into a jugular vein. A chest x-ray is also needed to verify proper placement before it can be used.
Use of an RN specifically for IV insertion by a hospital is probably for minimizing the potential for complications. Look at Paramedics... we start IV lines a LOT. Consequently, as a group, we're pretty good at it. Nurses on the floor might only need to swap sites every 3-4 days so they might not get a whole lot of practice at it. Therefore, it's probably a better idea to have a few RN's that only do IV's come and insert those IV lines than have a regular floor RN do it.
Use of an RN specifically for IV insertion by a hospital is probably for minimizing the potential for complications. Look at Paramedics... we start IV lines a LOT. Consequently, as a group, we're pretty good at it. Nurses on the floor might only need to swap sites every 3-4 days so they might not get a whole lot of practice at it. Therefore, it's probably a better idea to have a few RN's that only do IV's come and insert those IV lines than have a regular floor RN do it.
ExpatMedic0
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wildmed
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So last month I was at Denver Children's hospital finishing up my last 8 hour rotation for Paramedic school. There was a nursing student there who I got to chatting with and she told me that she was about to graduate the same week as me with her BSN. A little boy came in with possible menigitis and I volunteered us to start the IV, mainly because I wanted to beat the 4 year medical student in there to do the assessment.....anyways as we go in there and I start to assess the little guy I hand her a IV start kit and a 20 gauge and she turns BRIGHT red. I asked her what was wrong and she quietly told me that she had only started 2 IV's before. I don't know how many PVC's a minute I started to have but it was probably at least trigeminy.
So....has anyone else ran into this? How can someone be about to graduate with a BACHELOR'S degree in nursing and have started 2 IV's. Whats the catch here? I haven't heard any horror stories about nurses coming out of her school and in fact I know some ER nurses that went there that are great RN's.....It just blows my mind.
Honestly man,
Last time I checked nursing students are not even aloud to start lines at TCH, regardless of if they want to or not. There are some really great ED nurses in the world, but I would guess that 90% of the lines started in colorado EDs are started by techs, because in reality they just have more experience with it than nurses do.
Pneumothorax
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It depends on the nursing program, some feel IVs should be started on the job. Some feel they should be started on as many patients as possible.
You should understand that most of our pts in the hospital have IVs started so not much opp for a student to learn technique.
Also, it depends on the student- you only start out how many iv's you seek out
You should understand that most of our pts in the hospital have IVs started so not much opp for a student to learn technique.
Also, it depends on the student- you only start out how many iv's you seek out
mycrofft
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When I had my premature stint in an ER, I was required to get my ACLS, which included a manikin attempt for airway but again NO IV. The ER had me take a one hour class, then had me start all the IV's, partly because it turned out I had a knack, and it freed up they other fully seasoned RN's to non-technical stuff.
First time I tried drawing blood in a doc in the box, I tried to thread the Vacutainer needle into the vein!
First time I tried drawing blood in a doc in the box, I tried to thread the Vacutainer needle into the vein!
VFlutter
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It is common for nursing students to have very few actual sticks before graduation. We put hundreds in on manikins but are not allowed to practice on each other like some medic programs allow. I was able to get quite a few during my ER rotation but have not done one since (almost 6 months ago). On a med surg floor they already have IVs from the ER or some other form of access (port, picc) so there is really no need to place another line unless they infiltrate or something. Also you said it was a children's hospital, we usually get zero practice with children and I dont think we are allowed to place IVs during our Peds clinical. It it on the job training once you land a job in what ever area you choose. My one teacher is an ICU nurse and said she hasn't started one in 10+ years. No need on most floors.
I wouldn't say it is "allowed" it still happens I agree, however, there is a major problem for who will be responsible for the bill of any complications.
Many isurance companies, especially university provided ones, have an exclusion and do not pay for resultant complications if they arise.
The institution and instructors can also be held liable for damages for allowing the practice.
Places doing this are taking a gamble that nothing will go wrong.
At both the institutions I have taught at, allowing students to practice on each other is a firable offense. That includes "pretending" not to see or know.
I have said for many years not being able to practice on patients results in very poor education at any level of healthcare provider compared to other places in the world.
They spend millions upon billions on simulators, but it will never replace touching a patient.
It is a big problem.
VFlutter
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Agreed, however we do have some very realistic simulators. Pretty cool stuff, one actually gives birth and vomits.
I have played with surgical simulators that have realistic tissue layers.
But I can tell you, there is far less "pucker factor" cutting through simulated tissue than real tissue and far less double checking before.
I have also noticed that the simulated tissue cuts easier with a scalpel than with scissors, however, sometimes the exact opposite is true of real people.
mycrofft
Still crazy but elsewhere
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The moulage study I did last autumn turned up articles showing simulators only to be a little better than moulage for training, and moulage barely at all.
I guess a sim is ok for the first step. I let paramedic students try me twice and no more, ever.
I guess a sim is ok for the first step. I let paramedic students try me twice and no more, ever.
You are now on laerdal's hit list my friend.
mycrofft
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Booger 'em. I'm already a pariah of sorts for telling my FD to stop using moulage other than as a means of making trainees feel more "into" the whole scenario.