IV start service

[epidural man]

Background -

Training program with residents for several specialties, including Anesthesia.

I trained at my current workplace.

We ALWAYS get called for IV starts.

I think it borderlines on abusive.

I'm just curious if other hospitals use anesthesia services as the last stop for IV placement. Do you field phone calls while on overnight or weekend call to start IVs?

I'd love to say no - but that isn't the current culture.

I don't understand why I am the last stop. It is a skill that doesn't require a residency. In fact, I could argue I am the WORST out of all the services because my patients are non-moving with theoretically dilated vessels under anesthesia. But somehow I am the world's expert on starting IVs. I mean, I get it....we are damn good at it. But still.....

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[anaesthetic]

Some of us do it as a favor to the preop nurses. I get called often by colleagues to do US-guided PIVs. Anybody else (esp. ICU for PIVs, art lines, CVCs, etc.) and we just say we’re too busy and hang up.

The hospital has a dedicated PIV team (ie, one or two RNs) that runs around the hospital as a consult service for IVs. Once they leave around 4-5pm, everyone not in the perioperative area is usually SOL. I don’t mind it.

 

[vector2]

Background -

Training program with residents for several specialties, including Anesthesia.

I trained at my current workplace.

We ALWAYS get called for IV starts.

I think it borderlines on abusive.

I'm just curious if other hospitals use anesthesia services as the last stop for IV placement. Do you field phone calls while on overnight or weekend call to start IVs?

I'd love to say no - but that isn't the current culture.

I don't understand why I am the last stop. It is a skill that doesn't require a residency. In fact, I could argue I am the WORST out of all the services because my patients are non-moving with theoretically dilated vessels under anesthesia. But somehow I am the world's expert on starting IVs. I mean, I get it....we are damn good at it. But still.....

Our hospital:

Floor nurse
IV / midline team nurse (ICU nurses trained with ultrasound)
PICC nurse (during daytime hrs)
MICU / SICU resident/fellow if it's a pt on their service
Anesthesia... If we're free and feeling nice

 

[epidural man]

Our hospital:

Floor nurse
IV / midline team nurse (ICU nurses trained with ultrasound)
PICC nurse (during daytime hrs)
MICU / SICU resident/fellow if it's a pt on their service
Anesthesia... If we're free and feeling nice

I just feel like if it gets to this point, large vessel central access should be the next step. Anesthesia shouldn’t be in the chain.

 

[Status Sciaticus]

I'm at an academic NYC program. Theres typically a pathway that gets followed:

Floor nurse attempts to place IV once or twice.
If unsuccessful, they call a resident to attempt (stupid since they have less experience at placing lines)
If unsuccessful, an order gets placed for the PICC Nurse to place an IV or Mid-Line/PICC if indicated.
If unsuccessful, critical care gets paged (because they must be great at doing US guided lines.

It is dumb because if you cant get experience and get better if you just hand off the attempts to someone else. At this rate, the only PIVs the nurses will be able to place are 22Gs in veins that can take a 16G.

There is something to be said about helping out your colleagues and nurses. They do remember that, and often will help you out when you need help.

Anesthesia is not in the pathway at all unless its a preop patient coming in for a procedure/surgery or postop in PACU

 

[nimbus]

We rarely insert IVs on our own patients when the preop nurses can’t do it. We never get called anywhere else in the hospital.

 

[DirtDocMD]

We rarely insert IVs on our own patients when the preop nurses can’t do it. We never get called anywhere else in the hospital.

Yep.

There’s a nurse “IV Team”. If they can’t get it, then they call a similar team to do a PICC line.

Only time we get called is when the pt is in PREOP and the preop nurses can’t get an IV.

 

[Bryan O’Blivion]

I prefer to start my own IVs anyway. That way I know they will work.

Not sure I want to run around the hospital to provide this service, but I certainly don’t mind doing it when not busy.

 

[NICMAN]

Absolutely not. If it is a problem at the hospital then it is a problem with administration not putting out the money for an IV team. During this time of staffing shortages especially you should value your expertise and professional services and not be ordered around the hospital in the middle of the night doing nursing scut work.

Also, it teaches the Anesthesia residents that they are about the same level as nurses. Do you think the plastic surgery residents are treated this way. I would have a serious talk with your chair and make it clear that the Anesthesia department does not clean up nursing duties — especially in the middle of the night.

Also, other residents can learn how to do US guided IVs on their own patients.

 

[vector2]

Absolutely not. If it is a problem at the hospital then it is a problem with administration not putting out the money for an IV team. During this time of staffing shortages especially you should value your expertise and professional services and not be ordered around the hospital in the middle of the night doing nursing scut work.

Also, it teaches the Anesthesia residents that they are about the same level as nurses. Do you think the plastic surgery residents are treated this way. I would have a serious talk with your chair and make it clear that the Anesthesia department does not clean up nursing duties — especially in the middle of the night.

Also, other residents can learn how to do US guided IVs on their own patients.

I'm in concurrence with your sentiment but there are plenty of hospitals, especially non-training non-tertiary centers, where part of the anesthesia contract is that they are the line service.

 

[Mman]

have not seen it at big hospitals, but have seen at several smaller community hospitals where anesthesia gets called somewhere in the chain for a PIV. Not my favorite use of skills.

 

[pocafx]

WE get paged alot on the OB floor for IV. 400 lb er coming in for induction and they cant get IV. Lucky me gets to do IV and epidural on this ....

 

[IMGASMD]

In residency, we do get called sometimes to the floor. My standard answer, I will try to be there soon, but in the middle of something. We had a lot of kidneys, need at least a 22 before lining up. So we were seen as the best last line of defense.

My first job, never to the floor. Even in preop after the nurses tries for 3 times, the older partners will just send them to IR for PICC. If I am not busy, I will give it a try with US. So total opposite of where I was trained.

Next job, have a dedicated IV team, and hospital employed CRNAs. I started my own IVs a handful of times in preop, when I just don’t want to wait. Needless to say, no one ever calls us to start any floor IVs.

I think it’s a balance. When is it “educational”, when is it scut/abuse? I certainly think there’s some value to try to troubleshoot in less than idea situations (especially in residency), but just because you are good at something, doesn’t necessarily mean you want to do it when you have 10 other things to do.

 

[coffeebythelake]

I think it’s a balance. When is it “educational”, when is it scut/abuse?

Once you've done it a couple times it is not educational any more. It's a freaking IV.

 

[OTCAwesome]

Never been asked and would never be asked to start a PIV at my current gig. Quite frankly, if it has gotten to the point where they're asking me for a line, it's going to be the big one going into their neck.

 

[kidthor]

Have them consult IR instead. They can do lines and give us back all the blocks they’re trying to take.

 

[NICMAN]

I know this is done all the time. I am sure we could also be really great at cleaning bedsheets as well, but in this environment of labor shortages and high risk of burn-out this should be an agenda item for the next contract negotiations.

A job where I am called in on the weekend or in the middle of the night to do an IV is not the kind of job I would take--and I really like doing IVs. I am pretty good at it. I have never cancelled a case due to lack of access--never and I never will (and I very rarely have to resort to central access).

It isn't an issue of benevolence and taking care of the patient, it is an issue of knowing what I am worth and advocating for maximizing both my contribution and having that contribution recognized by not being underpaid, abused, or discounted by colleagues or administration. Any residency program that allows their residents to be the hospital IV start team (outside of OB--I understand sometimes this is necessary) is seriously devaluing their residents and teaching them a counterproductive lesson about their worth.

 

[Urzuz]

Have them consult IR instead. They can do lines and give us back all the blocks they’re trying to take.

Your radiologists are doing blocks?! 🤣

They are busy enough doing everything from chest tubes to LPs to CT guided ablations at my hospital…the last thing they’re looking for is more business, especially when there are perfectly capable physicians in the OR down the hall who can knock them out in <5 min.

 

[nimbus]

Your radiologists are doing blocks?! 🤣

They are busy enough doing everything from chest tubes to LPs to CT guided ablations at my hospital…the last thing they’re looking for is more business, especially when there are perfectly capable physicians in the OR down the hall who can knock them out in <5 min.

One of our GI guys does EUS guided celiac plexus blocks. It actually makes sense.

 

[IlDestriero]

In residency there was an IV team, but they didn’t work at night, so sometimes we had patients brought to pre op for an IV. A couple times we took one look at them and transferred them to the ICU emergently as they needed more than an IV, and sooner rather than later.
Now at my Children’s Hospital we have a 24/7 IV team that can ultrasound, etc. If they can’t get it there is a PICC line team or IR. We are not in the equation, unless the patient is coming to the OR, or it’s for IR sedation/anesthesia.

 

[nimbus]

For those doing IVs all over the hospital, do you get paid for this?

 

[jwk]

I've started tens of thousands of IVs in my career - but at my current job, the pre-op nurses do it, and if they can't get it, they call the IV team who brings their handy U/S and pop one in places I never would have considered, but run great. Once they get to asking us, it's one try (maybe) and then time for a central line.

 

[GassYous]

For those doing IVs all over the hospital, do you get paid for this?

It is worth like a unit

 

[anbuitachi]

i say no, but it annoys me a lot when they call at 3am for IV help

 

[GassYous]

i say no, but it annoys me a lot when they call at 3am for IV help

This has never happened to me and I'm sorry that it happens to you.

 

[Ashers]

My residency we got called for IVs all the time, peds, adult, at the hospital where we did OB for the general floors. It was obnoxious. I got called to the ER once for a patient to do an IV. Pt flat out told me she always has a PICC. I got an IV in her foot, and I told the ER call for a PICC, and do NOT push contrast through the 22g in her foot. What do they do? Push contrast through the 22g, and call me for another IV. I told them no, absolutely not. But we also had to do our own IVs on preop patients for most of residency (until my CA3 year) because "IVs aren't a nurse's job" according to the preop nurses. They changed it when they realized they could speed up turnovers by having IVs done before we saw them.

We'd also get called to do central lines on patients on the floor. I'd say no when they called me, some attendings would back me up, some would get upset, but I was like "we have other rooms running, and a trauma could come in!"

In private practice, I did a MAC case on a septic patient, came from the ICU with a good IV. Short case, brought her back to the ICU, and they were mad I didn't put a central line in when "she was asleep." I said "she barely got any sedation, you should've done it since she was septic. Not my job to do your lines for you."

 

[GassYous]

I like lines. How long does the line take that you can't finish it before the hypothetical trauma patient is evaluated, imaged, the OR room set up, and the patient brought to the OR? Even in the most inefficient setup with the weakest resident and toughest patient the line should be done and note in within an hour. Covid was a nice opportunity to put in a bunch of subclavians and dialysis lines that we don't normally place.

I think cvls are fun and the billing is okay.

 

[deleted875186]

I generally don’t mind putting in an IV with the ultrasound, especially if it spares the patient needing a CVC, typically I’ll put one in the upper arm similar to a PICC. But if I were at a hosptial were this happens frequently then I would be annoyed.

 

[coffeebythelake]

Floor patients coming to the OR with no working IV, the nurses don't even pretend that it was ever working. Ridiculous.

 

[IMGASMD]

Floor patients coming to the OR with no working IV, the nurses don't even pretend that it was ever working. Ridiculous.

“Patient in a hospital without IV,” I asked.

Nurse staring at me as if I have five heads.

 

[Arch Guillotti]

We'd also get called to do central lines on patients on the floor. I'd say no when they called me, some attendings would back me up, some would get upset, but I was like "we have other rooms running, and a trauma could come in!"

What service were you on as an anesthesia resident where you were called to do a central line on a floor patient?

 

[PpfSuxTube]

Rarely asked but when i do i bill a consult not an iv start.
If it were common and accepted culture i would strongly consider leaving

 

[The Duck Knows]

Rarely asked but when i do i bill a consult not an iv start.
If it were common and accepted culture i would strongly consider leaving

What is the reimbursement like for that consult?

 

[GassYous]

What is the reimbursement like for that consult?

Probably a few units depending on time like 30 mins+ or whatnot

 

[KetamineForAll]

We used to get called all the time. We started asking for the names of the nurses who had tried (supposed to be two people 2x) and the location they tried. We then told them we would come do them when we were free, but we would have to bill as a procedure "per hospital policy" (which was made up, but nurses always throw around the word "policy," so we did too). We rarely get called anymore

 

[OptionOffense]

The hospital has a dedicated PIV team

What a waste of money... THey are prob lazy bedside nurses. The responsibility for the iv and blood draws should fall on the primary team. we wonder why there is a bedside nursing shortage.

There is not a shortage of nurses, there is a shortage of bedside nurses. Lazy nurses with offices and file cabinets and clip boards we are over run with.

 

[nimbus]

What a waste of money... THey are prob lazy bedside nurses. The responsibility for the iv and blood draws should fall on the primary team. we wonder why there is a bedside nursing shortage.

There is not a shortage of nurses, there is a shortage of bedside nurses. Lazy nurses with offices and file cabinets and clip boards we are over run with.

I can see a role for a team that does IVs and blood draws all day every day and nothing else. Some nurses aren’t very good at it. It’ll prevent some patient suffering.

 

[coffeebythelake]

I can see a role for a team that does IVs and blood draws all day every day and nothing else. Some nurses aren’t very good at it. It’ll prevent some patient suffering.

Many of the new generation of nurses suck at IVs. Even those who are supposed to work in preop and getting patients ready for surgery, blowing veins left and right. Less exposure, less expectation, always calling for help.

 

[narcusprince]

In ASC land I get difficult IVs once every few days. I have zero problems helping the preop nurses out from time. Albeit I am well compensated for my services. After working for years in a system where we do all the IVs for all or starts I am happy to help. Helps instill we are all in this together.

 

[nimbus]

Many of the new generation of nurses suck at IVs. Even those who are supposed to work in preop and getting patients ready for surgery, blowing veins left and right. Less exposure, less expectation, always calling for help.

Our preop nurses are generally very good. But the things that pass for an IV on floor patients is astounding.

 

[2Fast2Des]

Our preop nurses are generally very good. But the things that pass for an IV on floor patients is astounding.

Yes, floor nurses are astoundingly bad. They are not exposed to it well as nursing students, and they practice on the job being taught by other nurses who suck as well. Unless it's an ED nurse, or pre-op nurse who do them frequently, I come in and see a giant ass vein and watch them struggle. Younger nurses suck in general, no dedication, they're just putting in their time to become NPs so they half ass it.

 

[coffeebythelake]

Yes, floor nurses are astoundingly bad. They are not exposed to it well as nursing students, and they practice on the job being taught by other nurses who suck as well. Unless it's an ED nurse, or pre-op nurse who do them frequently, I come in and see a giant ass vein and watch them struggle. Younger nurses suck in general, no dedication, they're just putting in their time to become NPs so they half ass it.

NP or CRNA or whatever. They see bedside nursing as below them and just a stepping stone. No effort. No skills.

 

[2Fast2Des]

NP or CRNA or whatever. They see bedside nursing as below them and just a stepping stone. No effort. No skills.

They suck at being a mid-level as well because they never had any dedication to the field or craft. Pan scan\order\consult for everything, overtreat or under treat, Not sure where the cost savings comes by not paying physicians and replacing them with substandard care. Perplexing... Same logic as pharmacies hiding sugammadex to save costs

 

[vector2]

IV teams make sense. Placing IVs on hospital inpatients is a nursing duty so having a team of nurses who are good at it saves everyone else like IR or us who are too well paid and too busy from wasting time doing floor IVs/central lines/piccs just for access.

 

[pmichaelmd]

We get called quite frequently. If the floor/SSU/ICU/L&D nurse can’t get access, during business hours, they will call the IV team (several RNs who are trained to place PICC and midlines) who often “can’t find anything.” We are then the last line. Def not in our contracts and we don’t mind helping when free and available, but it can get irritating to be called in overnight or on weekend call to do peripheral IVs. The surgeons sometimes get called for central lines if we aren’t available but they have gotten smart and simply say they are too busy.

What started as a courtesy has become an expectation. I don’t mind during usual work hours and it does keep our value at the forefront with admin because not every anesthesia group would agree to help like this. And, although salaried, we are well-compensated.

Same for intubations in the ICU or on the floor. Our intensivists by and large don’t intubate or do lines. We also get called by nephrology to place Vas caths.
Small to medium sized community hospital system here.

 

[nimbus]

Our intensivists by and large don’t intubate or do lines.

Then what do they do?

 

[2Fast2Des]

We get called quite frequently. If the floor/SSU/ICU/L&D nurse can’t get access, during business hours, they will call the IV team (several RNs who are trained to place PICC and midlines) who often “can’t find anything.” We are then the last line. Def not in our contracts and we don’t mind helping when free and available, but it can get irritating to be called in overnight or on weekend call to do peripheral IVs. The surgeons sometimes get called for central lines if we aren’t available but they have gotten smart and simply say they are too busy.

What started as a courtesy has become an expectation. I don’t mind during usual work hours and it does keep our value at the forefront with admin because not every anesthesia group would agree to help like this. And, although salaried, we are well-compensated.

Same for intubations in the ICU or on the floor. Our intensivists by and large don’t intubate or do lines. We also get called by nephrology to place Vas caths.
Small to medium sized community hospital system here.

Called in?? You guys actually come into the hospital from home to do an IV?? Dang

 

[pmichaelmd]

Um, manage stuff?

 

[2Fast2Des]

Then what do they do?

Tell the RN to run vaso on 22g piv in the hand with the BP cuff q20 minutes

 

[vector2]

. Def not in our contracts and we don’t mind helping when free and available, but it can get irritating to be called in overnight or on weekend call to do peripheral IVs. .

If it's not in your contract then I would be telling them to go fly a kite if they tried to call after hours or on weekends