Poor IV access

[rmabrey]

I've never personally stuck an IV, but during my time in the ER of both our major hospitals and my 13 or so ambulance shifts I quickly learned that discomfort or not, I want the medic doing it......Not an ER nurse. The ER is going to do it anyway if its an ALS patient.

 

[medicRob]

I've never personally stuck an IV, but during my time in the ER of both our major hospitals and my 13 or so ambulance shifts I quickly learned that discomfort or not, I want the medic doing it......Not an ER nurse. The ER is going to do it anyway if its an ALS patient.

Do you mean you would rather have it started on scene or en route, or do you mean you prefer medic, because RNs are quite capable of IV's, trust me.

 

[rmabrey]

Do you mean you would rather have it started on scene or en route, or do you mean you prefer medic, because RNs are quite capable of IV's, trust me.

I would prefer to never have an IV started en route, but I would trust any medic I have worked with so far to do it. I would prefer a medic, given my limited experience but I know RN's are quite capable, and I have seen some good ones.....I've also seen a lot more that werent as good.

But in defense of RN's, as I stated previously, if it is an ALS run for the service I have been at, the pt gets IV access, so they dont get as much experience and practice IMO.

ETA: Again my post sounds weird so I'll try to clarify. Rn's here work 8 hour shifts, whereas medics work 12's. In that time a nurse may start 1 or 2 IV's, or if at one particular hospital, they will have a staff medic do it so they may start none. A medic in the field will start ~8 on a normal day

 

[medicRob]

I would prefer to never have an IV started en route, but I would trust any medic I have worked with so far to do it. I would prefer a medic, given my limited experience but I know RN's are quite capable, and I have seen some good ones.....I've also seen a lot more that werent as good.

But in defense of RN's, as I stated previously, if it is an ALS run for the service I have been at, the pt gets IV access, so they dont get as much experience and practice IMO.

ETA: Again my post sounds weird so I'll try to clarify. Rn's here work 8 hour shifts, whereas medics work 12's. In that time a nurse may start 1 or 2 IV's, or if at one particular hospital, they will have a staff medic do it so they may start none. A medic in the field will start ~8 on a normal day

I'll agree with you that yes, there are some RN's that aren't as good with IV's, but that is true of every profession, even Paramedicine. As far as nursing goes, we usually work 3 12 hour shifts a week for full time, that is a pretty common schedule, although there are a few variations.

In an ER emergency unit of a Trauma I, it is not unheard of for an RN to average around 12 sticks per 12 hour shift, not to mention RN's spend more time in clinicals alone than a medic spends in their entire program. RNs that are also members of the IV team can average up to 30 IVs a shift. When I was on a dedicated IV Team, we would stick on every unit.

In my humble opinion, I would prefer to have an RN start an IV on me, unless I know the medic. However, we do not always get a choice in who sticks us, and if I required IV Fluids, I would be thankful to whomever got a patent IV line in me regardless of their title.

 

[usalsfyre]

One of the most talented folks I've ever seen at starting lines was actually a Basic who went to phlebotomy class and spent the next 10 years teching at a trauma center. That doesn't mean I want him making care decisions, just that he was good at a monkey skill.

If I had to pick, by "group", who I want starting lines in me it would be 1)anethestist of any sort 2) IV team RNs. Both of these sets of people can seemingly put patent lines in diabetic IV drug abusing marble statues with PVD.

 

[medicRob]

One of the most talented folks I've ever seen at starting lines was actually a Basic who went to phlebotomy class and spent the next 10 years teching at a trauma center. That doesn't mean I want him making care decisions, just that he was good at a monkey skill.

If I had to pick, by "group", who I want starting lines in me it would be 1)anethestist of any sort 2) IV team RNs. Both of these sets of people can seemingly put patent lines in diabetic IV drug abusing marble statues with PVD.

Well, of course we all want the anesthetist! lol. Anyways, I worked as a Lab Assistant II (Phlebotomy) while in nursing school. I got lots of experience, it did take time to get use to angles and depth when we got to our IV sections.

I counted in one shift as a Lab Assistant II, 35 sticks. Mind you, some patients you will stick multiple times a day: 6 am labs, STAT labs, Vanc peaks/troughs, updated BMP/CMP, lactate, BNP, you name it.

 

[rmabrey]

I'll agree with you that yes, there are some RN's that aren't as good with IV's, but that is true of every profession, even Paramedicine.

Agreed

As far as nursing goes, we usually work 3 12 hour shifts a week for full time, that is a pretty common schedule, although there are a few variations.

Most units are that way here, and again it varies by hospital, but the ER works 8's, I can only assume they prefer "fresh" nurses. The other major hospital is working 12's now that I think about it, but given a choice I would not go to that one anyway.

In an ER emergency unit of a Trauma I, it is not unheard of for an RN to average around 12 sticks per 12 hour shift, not to mention RN's spend more time in clinicals alone than a medic spends in their entire program.

Both our major hospitals are Trauma II, and I can only recall seeing a couple sticks by nurses, most were staff medics, students, or the life flight medic (that was my instructor also). Again it is probably just the particular area.

RNs that are also members of the IV team can average up to 30 IVs a shift. When I was on a dedicated IV Team, we would stick on every unit.

Im requesting them, Ill beg if I have to

if I required IV Fluids, I would be thankful to whomever got a patent IV line in me regardless of their title.

Can't argue that.

 

[jwk]

I would prefer to never have an IV started en route, but I would trust any medic I have worked with so far to do it. I would prefer a medic, given my limited experience but I know RN's are quite capable, and I have seen some good ones.....I've also seen a lot more that werent as good.

But in defense of RN's, as I stated previously, if it is an ALS run for the service I have been at, the pt gets IV access, so they dont get as much experience and practice IMO.

ETA: Again my post sounds weird so I'll try to clarify. Rn's here work 8 hour shifts, whereas medics work 12's. In that time a nurse may start 1 or 2 IV's, or if at one particular hospital, they will have a staff medic do it so they may start none. A medic in the field will start ~8 on a normal day

I think your assumptions stem from your admittedly limited experience. Remember that not every ER case is a trauma case or code that comes in by ambulance. There are lots of people who need IV's for any number of reasons - some for hydration, some for nutrition, some for repeated antibiotics, some for pain meds and PCA's, etc. The length of shift doesn't really mean much given the ups and downs of both EMS and ER caseloads.

 

[rmabrey]

I think your assumptions stem from your admittedly limited experience.

That would be a good assumption, and also that I've already said the Techs always end up starting the IV's

 

[Anjel]

That would be a good assumption, and also that I've already said the Techs always end up starting the IV's

I asked an RN who I was tagging along with in our Trauma center and she said she hadn't started an IV in over a month.

They have medics they hire as techs who go around doing them, That is one of their sole jobs. Even in trauma they have their crap ready and go in if it is needed.

I really could care less who sticks me. It's really hard to get a good vein on me. Last IV attempt took 7 tries. But 3 different people. I ended up looking like a junkie. It was the anesthesiologist that got it on the very last try. In my hand.

 

[medicstudent101]

You have paramedics that SUCK at starting lines on pt's.
You have paramedics that are AMAZING at starting lines on pt's.

You have RN's that SUCK at starting lines on pt's.
You have RN's that are AMAZING at starting lines on pt's.

You have pt's that have CRAPPY veins.
You have pt's that have GREAT veins.

Any combo of the 3 sections makes for how easy or difficult it's going to be starting a line on someone. Point being, there's a spectrum on both pre-hospital and definitive care as it pertains to how good or bad someone is on starting lines. So we shouldn't be too critical on someone if the situation allows.

If you're working a code, then by all mean someone that's proficient in IV's should be the one attempting. If you know you're not that great at getting lines then be man(or woman) enough to pass on the task to someone more capable. If you're lacking in the IV department, then PRACTICE. B)