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No. They should just learn to start IV. Patients have veins and you can get them without ultrasound 99.99% of the time. I think in the last 5 years I've had about 1 patient that we needed an U/S to get a PIV in. And that's out of 10,000+ patients. If you need the U/S, you probably don't know what you are doing. And if they are truly an impossible stick serious consideration needs to be given to a central line instead of a PIV if they will need access for any period of time.
Yes... he is super nurseRRN- surely you understand that your skills are advanced, and 99.9% of your average IV-inserting nurses cannot and should not be using ultrasound to place them.
RRN- surely you understand that your skills are advanced, and 99.9% of your average IV-inserting nurses cannot and should not be using ultrasound to place them.
Yes... he is super nurse
I think you are taking yourself too seriously and in the future you will be a one of those militant CRNA's who annoy me to death!What is with all the condescending remarks? Yes you should be able to place PIVs without ultra sound the vast majority of the time. For the other times its nice to have trained individuals that can get access without needing a central line. Im sorry but in my unit a single 24 gauge in the finger is not adequate access. Its my facilities policy to have a minimum of two WORKING 20 gauge IVs on all of our patients. If they are a GI bleed they need two large bore accesses.
I don't try to be "super nurse." I just take my job seriously and want nursing held to a high standard. I don't see how that is somehow offensive. Don't you want to be highly skilled at your craft? I simply want to be able to provide my patients with the same standard of care I would expect. If I cant see or palpate a vein easily why would I torture them by digging around for something Im not going hit anyways? If they need central access that is what they will get, but if you can easily/safely save them from getting a CVC and it's potential complications its a no brainer.
Im sure you did a rotation in MICU during your residency, you should be very familiar with the population of patients that come through. Can you honestly say you can hit a ESRD patient with grafts and +4 edema 99% of the time? Or get an 18 gauge in a 20 year IV drug user 99% of the time. I know sure as hell I can't.
Yes... he is super nurse
I think this is my favorite part.You have to forgive me, I have only worked at one hospital, that being a regional trauma center. I cant really speak to the resources/competencies of smaller facilities.
patient is severe diabetic, ESRD, +4 pitting edema, AV graft of left arm, obese, and history of IV drug use... Not all that uncommon in MICU. No need for this nurse to place an US PIV in 2 minutes with no risk of major complications.... I'll just have IM or anesthesia come place a central line and risk popping a pneumo and patient getting a chest tube...
Fat doesn't = +4 edema, one limb to stick, and destroyed superficial vasculature. 2-3 inch angiocath in the brachial or basic vein and problem solved in all of 2 minutes. "just get good at starting IVs" how about be skilled with the tools at your disposal, save time and resources, plus save the patient from unneeded pain or risk of complications.
Sounds like a pretty awesome patient population to starting IVs... Im kinda jealous.
I don't follow. You just perfectly described a patient that needs a central line or PICC and then talk about saving time and resources by placing a ****ty PIV in them. If you are placing enough PIVs with an U/S to feel like you are getting good at it, you probably aren't very good at starting IVs. And I say this as the person that gets called when nobody else can get the IV. If a patient needs a central line, placing an U/S guided PIV doesn't help them much at all.
Can an U/S be a useful tool for finding a vein for a PIV? Of course. Nobody would deny that. It's just extremely infrequently that you should be needing it.
This is a perfect example of an arrogant, condescending remark. You tell me I am not very good at starting IVs and you don't even know me. For your information I am very good at placing PIVs with/without US plus I am pretty damn good at placing CVCs. At my hospital we don't consult anesthesia for access. If there is a super hard stick they call our rapid team because 98% of the time we can get a good PIV, if not they get a PICC or an IJ. There are many times that patients are as I described earlier and only need access for one or two IV antibiotics. Why would they need to get a central line for something that simple?
Does using a glidescope over a C-Mac make you less capable of intubating someone the "old fashioned way?" Its pretty damn simple, use the tools at your disposal to get the job right the first time. If someone is a super hard stick, sure I could get a PIV without ultrasound but it might take 2 or 3 tries shooting for a vein based on its anatomical position. Additionally, why would I choose to put in a 22/24 without US when I could easily put 18 in with US that will stay for much longer, not infiltrate, and be able to draw labs for days?
If a patient needs central access then absolutely they will get it but don't kid yourself thinking that every person who doesn't have visible veins needs one. I know you get to bill for placing a CVC but do whats best for the patient and at least attempt to place a PIV with US before going straight for the big guns.
You hold yourself in such high regards that you feel it necessary to put down skilled nurses. Next time before you decide to bash on my posts at least be knowledgable about venous access because the patient I described absolutely does not need a PICC!. Go place a PICC in an end stage renal patient and risk destroying a future graft site, Im sure nephro and the vascular surgeon will thank you.
I didn't want to get ugly but you provoke me with all your hateful remarks.
This is a perfect example of an arrogant, condescending remark. You tell me I am not very good at starting IVs and you don't even know me. For your information I am very good at placing PIVs with/without US plus I am pretty damn good at placing CVCs. At my hospital we don't consult anesthesia for access. If there is a super hard stick they call our rapid team because 98% of the time we can get a good PIV, if not they get a PICC or an IJ. There are many times that patients are as I described earlier and only need access for one or two IV antibiotics. Why would they need to get a central line for something that simple?
Does using a glidescope over a C-Mac make you less capable of intubating someone the "old fashioned way?" Its pretty damn simple, use the tools at your disposal to get the job right the first time. If someone is a super hard stick, sure I could get a PIV without ultrasound but it might take 2 or 3 tries shooting for a vein based on its anatomical position. Additionally, why would I choose to put in a 22/24 without US when I could easily put 18 in with US that will stay for much longer, not infiltrate, and be able to draw labs for days?
If a patient needs central access then absolutely they will get it but don't kid yourself thinking that every person who doesn't have visible veins needs one. I know you get to bill for placing a CVC but do whats best for the patient and at least attempt to place a PIV with US before going straight for the big guns.
You hold yourself in such high regards that you feel it necessary to put down skilled nurses. Next time before you decide to bash on my posts at least be knowledgable about venous access because the patient I described absolutely does not need a PICC!. Go place a PICC in an end stage renal patient and risk destroying a future graft site, Im sure nephro and the vascular surgeon will thank you.
I didn't want to get ugly but you provoke me with all your hateful remarks.
Gassdoc, we definitely need to TALK!Make a mental note of that moment. If you take a job with an AMC such as Northstar, you will regularly get called in from home as an attending for s&*t like that. Don't like it? AMC's only provide claims-made malpractice insurance so you can always pay your own $15K tail and walk, while leaving behind any retirement that isn't "vested". Welcome to the future.
Oh, and if they deny this when presenting you a job, I've got a bridge I'll sell you too.
Well RRN, it's great that you have acquired a skill to place an IV and have become technically skilled at intubations and such. I think it might have gone to your head a little bit, that you have a skill that a lot of other people don't have. I could train a monkey to place an IV or to intubate. I think you should go on to become a CRNA. You've already got the "militant" part down pretty good. It doesn't take much to become a Crna. And you will never have to consult anyone ever for anything. You'll be that good.
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