We do have some patients who spend a lot of each year with us, and who have a tremendous amount of vein damage from years of multiple accesses. There are some that I know, regardless of hydration status, I cannot get with the ultrasound, due to massive stenosis. We consult on these patients, discuss them with I.R., and help arrange something for them. There are times that the docs or nurses try to demand I insert a PIV in a pt that I know I cannot get. I don't stick them. We don't call that "No Vein." We call it "Lose My Pager Number."
Leigh Ann
-----Original Message-----
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Sent: Tue, 10 Oct 2006 7:24 PM
Subject: RE: NO VEIN
When we add the use of infrared light devices to visualize veins, this problem will greatly decrease. Lynn
At 4:33 PM -0400 10/10/06, Nancy Moureau wrote:
>I think this term applies to vein mapping especially when thrombosis is
>present in multiple veins of the arm. No vein status might apply if no
>suitable vein existed for fistula or graft. That no vein status would not
>pre-empt placement of a peripheral catheter since it is impossible to see
>inside any given vein without ultrasound or other aid, and as Lynn so
>eloquently stated, things change. This may be a policy we need to develop as
>more ultrasound assessment is employed with peripheral veins. Elizabeth,
>this No Veining appears to be something we need to discuss more!
>
>Nancy Moureau, BSN, CRNI
>PICC Excellence, Inc.
>888-714-1951
>www.piccexcellence.com
>[EMAIL PROTECTED] >
>
>
>-----Original Message-----
>From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]
>On Behalf Of Lynn Hadaway
>Sent: Tuesday, October 10, 2006 2:21 PM
>To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
>Subject: Re: NO VEIN
>
>
>
>First, I have never seen or used this concept of labeling a patient
>as No Veins.
>
>A patient may present with no peripheral venous access today due to
>fluid volume deficits, a catheter is placed in the AC to get in some
>fluids, then a couple days later has several peripheral sites
>available. So this can change from day to day.
>
>If a patient has a long history of IV therapy and truly has extremely
>limited peripheral sites for IV access, then your team would need to
>be proactive about getting some other type of catheter inserted -
>midline, PICC, other central line. To identify this situation and
>continue to try to obtain peripheral access would subject the patient
>to unnecessary pain and trauma and significantly drive the costs up
>for your facility.
>
>The criteria for using a short peripheral catheter as the preferred
>type of catheter include:
>1. therapy that will be required for less than a week
>2. therapy with a pH between 5 and 9
>3. therapy with a final osmolarity less than 600 mOsm/l
>4. no vesicants
>5. sufficient peripheral venous access sites to manage a week of therapy
>
>If the patient does not meet these criteria, another type of catheter
>should be chosen. If this happens, your problem goes away. The idea
>is the right catheter for the right patient at the right time or the
>catheter with the greatest likelihood of delivering the entire course
>of therapy with the minimum number of catheters used.
>
>Lynn
>
>
>
>At 9:19 AM -0400 10/10/06, [EMAIL PROTECTED] wrote:
>>1) Does anyone have a Policy and Procedure (or thoughts on) regarding
>>"No Veining" a patient? What criteria do you use to decide a patient
>>has no peripheral venous access? When do you reevaluate the patient,
>>if a central line has not been placed? What do you document?
>>2) If you have documented that a patient is "N/V" and someone else
>>comes behind and places a PIV, what are the legal ramifications? How
>>do you prevent other staff from overriding the IV Teams expert opinion
>>for "no veining" the patient?
>>
>>Thank you....
>>
>>
>>Elizabeth A. Raucci, RN, MSN, MHA, OCN, CNS
>>ADMINISTRATIVE MANAGER: IV Services
>>MANAGER: Dialysis and Apheresis Contracts
>>Phone: (203) 855-3891
>>FAX: (203) 855-3893
>>Beeper: (203) 831-7593
>
>
>--
>Lynn Hadaway, M.Ed., RNC, CRNI
>Lynn Hadaway Associates, Inc.
>126 Main Street, PO Box 10
>Milner, GA 30257
>http://www.hadawayassociates.com
>office 770-358-7861
-- Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
At 4:33 PM -0400 10/10/06, Nancy Moureau wrote:
>I think this term applies to vein mapping especially when thrombosis is
>present in multiple veins of the arm. No vein status might apply if no
>suitable vein existed for fistula or graft. That no vein status would not
>pre-empt placement of a peripheral catheter since it is impossible to see
>inside any given vein without ultrasound or other aid, and as Lynn so
>eloquently stated, things change. This may be a policy we need to develop as
>more ultrasound assessment is employed with peripheral veins. Elizabeth,
>this No Veining appears to be something we need to discuss more!
>
>Nancy Moureau, BSN, CRNI
>PICC Excellence, Inc.
>888-714-1951
>www.piccexcellence.com
>[EMAIL PROTECTED] >
>
>
>-----Original Message-----
>From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]
>On Behalf Of Lynn Hadaway
>Sent: Tuesday, October 10, 2006 2:21 PM
>To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
>Subject: Re: NO VEIN
>
>
>
>First, I have never seen or used this concept of labeling a patient
>as No Veins.
>
>A patient may present with no peripheral venous access today due to
>fluid volume deficits, a catheter is placed in the AC to get in some
>fluids, then a couple days later has several peripheral sites
>available. So this can change from day to day.
>
>If a patient has a long history of IV therapy and truly has extremely
>limited peripheral sites for IV access, then your team would need to
>be proactive about getting some other type of catheter inserted -
>midline, PICC, other central line. To identify this situation and
>continue to try to obtain peripheral access would subject the patient
>to unnecessary pain and trauma and significantly drive the costs up
>for your facility.
>
>The criteria for using a short peripheral catheter as the preferred
>type of catheter include:
>1. therapy that will be required for less than a week
>2. therapy with a pH between 5 and 9
>3. therapy with a final osmolarity less than 600 mOsm/l
>4. no vesicants
>5. sufficient peripheral venous access sites to manage a week of therapy
>
>If the patient does not meet these criteria, another type of catheter
>should be chosen. If this happens, your problem goes away. The idea
>is the right catheter for the right patient at the right time or the
>catheter with the greatest likelihood of delivering the entire course
>of therapy with the minimum number of catheters used.
>
>Lynn
>
>
>
>At 9:19 AM -0400 10/10/06, [EMAIL PROTECTED] wrote:
>>1) Does anyone have a Policy and Procedure (or thoughts on) regarding
>>"No Veining" a patient? What criteria do you use to decide a patient
>>has no peripheral venous access? When do you reevaluate the patient,
>>if a central line has not been placed? What do you document?
>>2) If you have documented that a patient is "N/V" and someone else
>>comes behind and places a PIV, what are the legal ramifications? How
>>do you prevent other staff from overriding the IV Teams expert opinion
>>for "no veining" the patient?
>>
>>Thank you....
>>
>>
>>Elizabeth A. Raucci, RN, MSN, MHA, OCN, CNS
>>ADMINISTRATIVE MANAGER: IV Services
>>MANAGER: Dialysis and Apheresis Contracts
>>Phone: (203) 855-3891
>>FAX: (203) 855-3893
>>Beeper: (203) 831-7593
>
>
>--
>Lynn Hadaway, M.Ed., RNC, CRNI
>Lynn Hadaway Associates, Inc.
>126 Main Street, PO Box 10
>Milner, GA 30257
>http://www.hadawayassociates.com
>office 770-358-7861
-- Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
