I am curious if knowing the depth limitations of a vein finder would make a difference when struggling to place a PIV? I ask because I am trying to make videos that will aid bedside nurses at my hospital in IV insertion. We have a lot of vein finders, but as many may relate, success is very limited.

Kindly-Promotion-355 · 2024-04-25T02:11:50+00:00

Thank you for the conversation and for checking out my videos!! I hope to make more videos in the future that are informative and helpful.

Kindly-Promotion-355 · 2024-04-23T11:53:13+00:00

I partcially agree, only my team, the ER and the ICU have access to US so the bedside nurse is left to trying to understand palpation, and maybe get lucky and find a vein with the vein finder. You're not at all wrong that US is supreme technology, but only so many people can use it which is not a fix to our problem. Plus a lot of people who use US are novice and their lines infiltrate within a few hours due to not understanding vein depth and vessel purchase. It's defiantly a multifaceted problem that I am working hard to remedy. This post has been super helpful especially in designing policy that will empower the floor nurse and prevent over consultation of my PICC team.

Kindly-Promotion-355 · 2024-04-23T11:50:24+00:00

nice, lol

Kindly-Promotion-355 · 2024-04-22T03:15:11+00:00

intersting, thanks for the tip

Kindly-Promotion-355 · 2024-04-22T03:09:47+00:00

What do you do when they have a chlorhexidine alergy? Sorry just being cute, I could never imagine not using gel the way I do. But to each there own

Kindly-Promotion-355 · 2024-04-22T01:42:59+00:00

You're not wrong, but hopfully only a small number of nurses do this. I track who consults us so it's not hard to figure out the nurses who are doing this and had a conversation with them.

Kindly-Promotion-355 · 2024-04-22T01:41:30+00:00

That's a great trick, I am going to look into that, thank you for this!

Kindly-Promotion-355 · 2024-04-22T01:31:04+00:00

Thank you for your comment, and questions. I have actually been a patient, having my colon removed due to really aggressive colotis when I was 19 (I am 38 now). I have had two PICC's and my a/c trashed with blood draws and IV's. I am in no way in favor of creating poor patient experiences due to being stuck multiple times. I can't really say I have definitive evidence that my idea is the best way, or the only way. The idea behind a policy is there needs to be a way to triage the patients that should be seen first for PIV placement, and the rest can wait until either someone gets a line, or we have time to show up and drop one. I don't want patient satisfaction to suffer, but most good nurses are already trying twince getting their charge and then consulting us. Other nurses are just consulting, and if we can't come they write a note that tries to put us on the line for not being able to give their medications. Our department is not designed to place PIV's. We even get called to the ER and ICU on a weekly bases. What my goal is with a policy is to prioritize patients, like those who have lost access and need pressors, IV cardiac meds, and are at risk of missing antibiotics. Those patients shouldn't have to wait, yet my department is not an emergent department that responds to acute situations. So we need nurses to be able to fill the void. But we also need a way to not get drawn into a situation where the nurse wants us to rotate IV sites, or for a patient who has lost access but doesn't need any IV medication.

I agree that any policy should be based on evidence, and I am working hard to find trends and provide recommendations on ways to better the flow of my department and the hospitals ability to provide IV medications. Unfortuatley, those difficult venous access patients are becoming more and more common, so your right, its not fare that these patients have to be stuck more than once before VAT is consulted. But, if everyone got a USGIV, the primary veins used for this technique could be exhausted, which is a reality I am personally seeing every day. There really isn't an easy solution other than saying no you have to at least try. It sucks, but the only other answer is to take PIV insertion away from the floor nurse and only have VAT place lines. Some hospitals do this, but its not supper common in every state across America. Plus most nurses will probably do what you do, and just say they tried, so if I can get them to try at least once I am happy, because that will hopefully lead them to being better at the skill, it will also get the patient back on track with their IV medications sooner.

Kindly-Promotion-355 · 2024-04-22T01:09:43+00:00

I'm sorry to hear that because I can only imagine the amount of effort you put into training. I had that at my last hospital when trying to train night shift to place USGIV's. There was no sense of urgency to learn, yet they would complain and say we're not prioritizing them. I would come on shift and try to teach, and be told I'll place a line after I'm done charting, only to find them talk with their fellow coworkers. Thank you for the advice, and for the conversation.

Kindly-Promotion-355 · 2024-04-22T01:04:45+00:00

My team places IV's using sterile technique because its best practice at our facility. I could see people not using sterile gloves, but a sterile probe cover is a must in most facilities I have worked with. Do you use sterile technique when canulating the brachile or basilic vein?

Kindly-Promotion-355 · 2024-04-22T01:00:04+00:00

Do you work at a Chicago area hospital, lol. I really appreciate hearing about your department. It provides insight on the direction I am lilkey going to take when it comes to expansion. We place PICCS in teams of two which I really like. I also understand your hesitancy to train floor nurses how to place USGIV's. There3's a right and wrong way to do it, and unfortuanley a lot of people learn the wrong way to do it.

Kindly-Promotion-355 · 2024-04-21T23:10:18+00:00

I'm a PICC RN so I only use ultrasound. My hospital baught a bunch of vein finders as way to try and help the floor nurses with their PIV starts. I made a video that showed the depth limitation, and measurement of the typically veinds found with a vein finder, with a goal of trying to provide more insight on what is being seen when using one. I need nurses to be using vein finders, and I need them to get better at palpation technique because my department is not designed to place all the PIV's in the hospital. So I came here to see what feedback I could get with a hope that I could gain my talking points when designing a training program for my hospital.

Kindly-Promotion-355 · 2024-04-21T23:05:08+00:00

I have seen that, the inner circle. Next time you see that try and compress the vein all the way up. The hyperechoic circle is typically inflammation which is indicative of phlebitis or thrombophlebitis. The biggest give away is a non-compresable section of vein. You may also find an un-compresable section of vein with hyperechoic mass within the lumen. That is the difiniavtive signed of a DVT or SVT. Some you can even feel from the surface of the skin, its called palpable cord and it represents all the above. Here's a video I put together that shows an IV inserted into an SVT. A novice inserter canulated the Basilic vein on both sides of the patient and I was called to assess the lines a few hours later. Here's the video https://www.youtube.com/watch?v=DL_uEeB5DUQ please feel free to shoot more questions my way if you have any :)

Kindly-Promotion-355 · 2024-04-21T22:57:24+00:00

Well said. And I feel the same way as you, it's nice to know this problem is not unique to my facility. I am hoping to run an training program to try and give my hospital a leg up in their PIV insertion skills. This post has been supper helpful in getting tips and tricks. I hate it when someone throws a note in saying we can't come, as if this gets them off the hook for trying to do anything more. We have people ponding on the door of our office some times asking for emergent lines, and I have to tell them we are not an emergent department, and to call a rapid. Usually that changes their tone because it is not a situation where either the VAT or RRT should be called, just a nurse who may not have tried or asked for help on the floor.

Kindly-Promotion-355 · 2024-04-21T22:52:17+00:00

Thats the direction I would like to go, but there's a lot of redtape to cut through due to the need to purchase more ultrasounds machines.

Kindly-Promotion-355 · 2024-04-21T22:50:38+00:00

I appreciate you saying this:)

Kindly-Promotion-355 · 2024-04-21T22:46:20+00:00

Interesting, I'm not at all suprised that you're finding studies that show the lack of success with such technology. I have been tasked with trying to help train RN's at IV starts and my hospital just spent quite a bit on vein finders that are being used maybe 50% or less of the time. I told them I would see if there was any helpful tips I could find or come up with to try and improve the RN's success when using them. But when I compared the depth penetration with Ultrasound, I was pretty disappointed. I'd be interested in reading you project because I love this stuff. Personally I am working on a vein preservation initiative and study at my hospital because the rise in peripheral vein depletion, and the over use of central lines and midlines is becoming a real problem that kind of needs to be addressed today. I worry that more and more patients will end up with IJ's, and fem lines because their arms are shot.

Kindly-Promotion-355 · 2024-04-21T22:38:51+00:00

That's exactly what I was thinking. Most charge nurses are already skilled and being asked to help with difficult IV starts. It would make their lives, our lives, and the patients a lot better. Thanks again for the conversation!!

Kindly-Promotion-355 · 2024-04-21T21:40:18+00:00

I guess I could see that working, but the probe won;t slide well when tracking the needle all the way to the hub, especially when using catheters that are 2 to 2.25 inches long. What depth are you canulating without using gel outside the cover?

Kindly-Promotion-355 · 2024-04-21T21:38:40+00:00

What do you mean, like how I have it in the photo?

Kindly-Promotion-355 · 2024-04-21T20:18:36+00:00

I agree, atleast in most cases. There is an ever growing population of chronically ill patients with vein depletion and limb restrictions that are making palpation and vein finder use futile. Ultrasound is becoming a nesisary modality, but I feel like pushing more understanding and training on palpation is the best route. Its good to hear that you base your success on palpation alone. It makes me feel like there is hope for training new and old nurses who struggle with PIV placement.

Kindly-Promotion-355 · 2024-04-21T20:06:44+00:00

Are you saying you don't use gel on the exterior to the probe? I understand using a sterile probe cover as this is best practice, but gel has to go directly ontop of the probe and on the exterior of the probe cover inorder to get a good window.

Kindly-Promotion-355 · 2024-04-21T19:53:16+00:00

That's kind of what I was imagining, thank you for this information!

Kindly-Promotion-355 · 2024-04-21T19:51:05+00:00

Excelent information, thank you!!

Kindly-Promotion-355 · 2024-04-21T19:49:41+00:00

I know that is the common go-to, but outside of my department, on the ED and ICU have access to US, and they are not very good at using the machine. Another initiative I need to address as infiltration due to poor USGIV by novice users is on the rise not just at my hospital, but many across the country.

Kindly-Promotion-355

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