A patient recently told me that she has bad veins and expect to be stuck numerous times for a peripheral IV insertion. I asked her how many times did the nurses stick her before they got an peripheral IV ? She replied:
Oh, “it depends on the nurse but they keep sticking me till they get an IV in”. Sometimes, they have to call for help, and that other nurse will stick me several times and not even get an IV in, but I’m used to that. They eventually get one in and when I start getting my IV fluids, I’m afraid, it’ll start leaking from the holes in my arm”
It was hard to tell how the patient really felt about this. Was she bragging that she’s a difficult stick and a challenge to any nurse trying to start her peripheral IV? Or was she dissatisfied with the unsuccessful attempts by the nurses. Whatever the case maybe, one thing I’m sure about is that – patients(and providers) should be aware of the Infusion Therapy Standards of Practice 33 practice criteria F
Make no more than 2 attempts at short peripheral intravenous access per clinician, and limit total attempts to no more than 4. Multiple unsuccessful attempts cause patient pain, delay treatment, limit future vascular access, increase cost, and increase the risk for complications. Patients with difficult vascular access require a careful assessment of VAD needs and collaboration with the health care team to discuss appropriate options.
I informed the patient about this particular standard, to which she replied, “I don’t think my nurse knows about that because they keep sticking me until they get an IV in”.
It’s really sad to hear this but I do know many clinicians are not aware of the practice criteria and/or the limit. They may know the “no more than 2 attempts” per clinician but now the standard states: “limit total attempts to no more than 4”. Yes, there will be times when even the most proficient nurse will be unsuccessful, hopefully, they’ll get it in on the second attempt. This standard/practice criteria applies to all settings where patient care is delivered, even when patients are receiving infusions at home / physician office and there are no other nurses available.
Let’s stick to the Infusion Therapy standards of practice and share the information with our nursing colleagues. You may not call yourselves “infusion nurses” but the standards does apply to you too.
- Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs. 2016;39(suppl 1).