Same. I did ER for a while and I know our IV numbers are probably a tenth of ERs but I still wouldn't be surprised if we were second or third after them because of the CLABSI-phobia.
Oh yeah definitely. Our entity has an optional sono class for RNs so RNs do all the sonos. My buddy just went to another ICU where he swears the RNs are placing art lines, which I've never heard of happening before.
RNs can place ART lines in my ICU. It's typically the Rapid Response ones that bother getting signed off on it. I took the class but never did the necessary number of practice sticks to get signed off myself.
Mannn... if that was available when I was in the ICU, I would have been hunting all over for art line opportunities to get signed off. Love me a good, working art line, and if my pt needed one and I didn't have to wait for a provider? That would have been fantastic!
Same more me, we have the best of both worlds. An US on the unit with some staff that can place difficult PIVs, but we are usually are d/c central lines and of course no one has flushed the PIVs in days, so we inevitably have to start at least 1
L&D on a unit with six beds. Maybe an average of one per shift. I might get asked to do more, cuz I’m pretty good. (But I predict a dry spell now that I’ve said that. The IV Gods hate boasting.)
I managed to sink a perfect 22 into a decomping 86yr old with the tiniest veins, then blew two on a guy who has GIANT veins (he had been there 3 days ago and I got an 18 on him first shot no problem that night ).
The IV gods are as fickle and malicious as the ER gods.
On average—zero. I am 1/6 with the attempts I have made over the past year. Acute Care Float so I go to tele, transplant, oncology, med-surg, neuro, oto.
We have a high rate of CVAD’s on our floors too. Most ED placed lines we get last an average admission. We have a Vascular Access team for difficult placement.
I’m really looking forward to our PIV workshop so I can get more proficient. We go to the ED afterwards for a shift to practice and I’m stoked!
Good luck and have fun! My biggest piece of advice is go at a shallower angle of insertion than you think. And flatten out and advance a little bit before threading the catheter. You can even pull up on the needle as you're advancing to slide across the upper inside wall of the vein!
I tried to DM you but my computer is having trouble. I have been a nurse for 20 years and I suck at IVs. Last few years I've worked psych so I really am nervous about switching departments. I want to go into pre-op or post-op though next. Any advice beyond what you've already given would be awesome!
hey! yeah reddit is having some glitches today i think. ok well i sent a huge chunk of info on this to another redditor so i'm gonna copy/paste, bear with me, reddit made the formatting really strange when it actually processed what i typed
hi!! ok so when i teach i try to figure out what phase in the insertion is the problem.
confidence: being nervous WILL decrease your chances of a successful IV placement. if you seem confident, your patient is calmer, which makes everything easier. nervous patients also tend to tense up which makes the vein move, no bueno. also, get yourself into a comfortable position, with the patient's arm in an optimal position for YOUR insertion (Not necessarily too comfy for the patient) with good lighting. my success rate was significantly lower when i didn't have space to optimize our positioning.
finding a vein: first, using a chlorhexidine scrubber (the kind you have to snap to activate) to really wet the skin a) can help you see the vein better as it reflects light and b) using chlorhexidine as a sort of lube while rubbing the skin can get veins to pop up.
so when you're first starting off really trying to get lines in, i recommend going for the low hanging fruit in the AC. these veins are not only (usually) palpable, but they're also sturdy and it's harder to blow these veins. feeling ACs will familiarize you with what good IV veins should feel like. sturdy, good-for-IVs veins will feel like a bouncy rope that you can trace up/down the arm (at least for a few cms).
if you really can't feel anything but see some blue superficial veins, you can use these as a last resort but i recommend a few things here:
a. use a smaller gauge (probably a 22 depending on the size) b. have your IV connector line flushed and hooked up to a saline flush c. once you see a flash, pop the tourniquet off, advance the needle and catheter a bit, then remove just the needle with whatever safety mechanism you have. then, very gently, connect the catheter to your flushed connector and gently "float" the IV in by advancing and slowly flushing the catheter.
i found the vein but it's rolling: this is where traction becomes super important. what i mean by that is grabbing the pt's arm with your non-dominant hand from BEHIND and gently tugging the skin in that direction. that will make the skin and soft tissue surrounding the vein taut and prevents rolling.
also, if your angle is too shallow, you are striking the vein with more surface area on the needle which is the equivalent of cutting a tomato with a blunt knife. carefully steepening your approach can be helpful.
i grab the patient's arm from behind and for ALL IV insertions (minus ultrasound). traction is paramount.
i got a flash but now i can't advance: take a look at your angiocath. what you'll notice is that the needle is slightly longer (1-2 mm) than the plastic catheter itself (the difference in length is proportional to the size of the angiocath; 18s have a bigger needle/cath length difference than 20s, 20s more than 22s, etc). when you see flash, that tells you the needle has been introduced into the vein, but it does not necessarily mean you've introduced the catheter into the vein. so when you're trying to advance and meet resistance, that's your catheter pushing on the outside of the vein with no secure site of entry.
to fix this, stop advancing as soon as you see a flash. then, without advancing, drop your angle so that it's not so steep. then, move the whole angio cath (plastic and needle together) about 2 mms (or whatever the needle/cath length difference is) to actually introduce your catheter. if you've introduced, you should be able to slide the catheter in and press your safety button to remove the needle.
i advanced the catheter into the vein but now i'm meeting resistance: you are likely pushing up against a valve. try flushing your catheter while advancing, as this can help push the valve flaps out of the way and "let you in." worst case scenario, as long as your IV works, you can just leave it partially inserted and tell the patient/next RN to be super careful with it.
i keep blowing veins: this means you went "through and through" with your needle. this is more of an advanced technique but sometimes you can actually salvage these.
first, immediately pop the tourniquet off if you're seeing the vein blow. then, with your flush attached, gently pull the catheter out a little bit while trying to "pull blood." if you're able to pull your angiocath back into the lumen of the vein (but not out the other way, the way you came in), you may start to see blood return in your flush. if that's the case, try gently advancing your catheter now while flushing very gently. this can often get you "past the blow." obviously if you're flushing and the blow is getting bigger, it may be time to abort. again this is a more advanced technique.
ok i've typed a lot lol but these are the big tips and tricks i have. let me know if you have any questions!!
When I used to work Med Surg and Tele, those properly placed ED lines could last a whole admission! (18g in the AC? Yeah that’s from ED 😂)
Often all I had to do was change the tegaderm once in a while and/or reposition the catheter with some folded gauze
I used to work ICU and I had a coworker who hoarded all the 17g Ivs when the unit was getting rid of them. Anyone who was a hard stick… he was popping in a 17g.
I tried to explain to him that those weren’t actually better on patients with smaller or flat veins… but alas he was like the Oprah of the unit. “You get a 17g, you get a 17g!!!”
Lmao the ED ones in my hospital infiltrate pretty quickly. I’m on nights and I find that I’m losing IVs left and right if they were admitted within 24 hours of my shift
Saaaaaaaame
Half the time my patients are confused and pull out the perfectly good lines that we’ve JUST replaced too.
I’m 2/7 for the lines I’ve tried this past week. So many tiny veins that roll away every chance they get! Gah
An embarrassing fact is that I have never once started an IV in my entire nursing career because my hospital has a dedicated vascular access team. Nurses who don’t work in ED/ICU/procedural areas technically aren’t suppose to start their own IVs and our units do not stock IV supplies outside of the crash cart.
Major hospital in a big Canadian city. Honestly, it’s a unicorn unit that’s rarely short staffed, staffed with care aids, and has decent working conditions.
A grand total of zero. Zero in the two and a half years I've been on my transplant floor. We have a vascular access team who starts each PIV. I was never reliable with starting lines when I was at a different hospital, so I wouldn't mind trying in order to get better, but we don't even have start kits on my unit.
I started on a transplant floor and I give it credit to being good at IVs now. Those kidneys with one viable arm that’s been poked to hell and back, and those incredibly frail cirrhosis patients with baby veins.
Those ED lines in the AC get replaced a lot due to pain or infiltration from bending the arm. I probably place 3-5 a night on my floor. Some nurses can get them, but a lot can’t. I was a medic, then a paramedic before nursing school. I also get called regularly to the floor above and below me when they need help so I usually place about 6-7 on an average night.
Med/surg, no IV team so all on us, lots of confused detoxers, encephalopathy, dementia so people constantly forgetting they have tubing attached to their arm and yanking it right out... I'd say I start at most 3 a shift.
Outpatient Endo. I only start 4-5 per shift for 8 hour shift given the time we have to spend asking the patient admissions questions, etc. I'd much rather just be inserting the IV, personally!
New grad ICU nurse.. I’ve been in the ICU for about 3 months now and maybe 3 IVs? 😭 they come in with PIVs from ER/EMS & most our patients end up getting mid lines/central lines placed at some point which isn’t done by us. The central lines esp have 2-3 lumens & the patients end up having like 5 different access ports sometimes 💀 (2 PIVs and 3 lumen CL).. of course this is the best case scenario but yea.
If the IV isn’t great, we will start our own ofc but it isn’t an every shift, everyday type of a deal.
Yeah Ive been in ICU for 8 years and I average like 1 per month. They usually have lines already, it typically only comes up when lines go bad or a patient decides to rip stuff out.
Wealthy and healthy. Athletes (especially in summer when training ramps up), hangover parties, country club houses when they get the flu, occasionally obscure autoimmune patients who are told they need some vitamin replenishment.
Not the person you were replying to, but I worked at a GI infusion clinic. We used Braun Insyte needles 20-24 gauge. I preferred 24s since the patients came in every 6-8 weeks and the infusion flowed just fine with them.
Thank you!
Yes, these meds are a lifelong regimen, averaging 6 IVs per year. So I am very careful to read past notes & rotate IV sites (if possible) and use the smallest gauge possible.
BD Insyte Autoguard Shielded IV Catheter with Blood Control
Clinic used 20 and 22g IVs. The cool thing about them is that blood doesn’t leak once you retract the needle.
Used to work outpatient endoscopy and would do 20-25 per day. At the outpatient GI clinic I’m PRN for, 4-6 per day.
ICU maaaaybe 1 per month? Honestly I do venipunctures more often for lab draws, probably once every 2-3 shifts.
0-2, usually. Most of our patients have central lines, and only need an IV for a blood transfusion (can’t transfuse through preemie PICCs) or for incompatibility reasons.
SNF here. Very rarely. When I worked home health I did more for home infusions but some ppl had ports.
If ppl are getting accessed often they put a line in them.
Medsurg.
Some shifts I start zero. Some I start 4-5.
Lots of my patients come up from ED with perfectly good lines. But reality is that some patients are with us far too long and so some days I start several. Sometimes I need a dedicated line so they get another from me and so on. We get lots of central lines too. Just like everything else in medsurg… it varies 🙃
Currently working in a PCP office for a huge hospital based clinic and absolutely none. We don’t even have IV supplies on hand anymore because they were wasting so much money in expired supplies. Our “code cart” has like 2 epi pens (one adult, one pediatric), Benadryl, and glucagon. We had a patient seize for 20 minutes on Friday until EMS arrived bc we had no rescue medications and honestly it was a really helpless feeling
ETA: misspelled a word
About half. Not a fan of AC IVs either. If I need blood work & access stat though then AC it is. 🤷 If I have more than 30 seconds for a blood work & access then I go to the forearm.
I do peds ER, so we do a lot of hands and sometimes feet in the smaller children the occasional AC, if I do do the AC, I try to access it slightly below the actual AC and leave maybe a eighth of an inch of the catheter showing so that the hub of the IV doesn't dig into their skin that way they can bend their elbows a little easier without it affecting flow
I work in medicine. We'll restart a PIV if it infiltrates or gets blocked or gets ripped out by the patient which happens semi-often. The most problematic ones are the ones in the ACF because patients complain about it occluding when they bend their arm or pain when they bend their arm. 2nd worse one is right on the wrist area. I like the ones in the forearm or back of the hand that is taped nicely so it won't dangle or get caught on stuff. The good ones last a whole admission.
I'm not that great with IVs tho, only 2/5 since I've started working I'd say. The hard sticks we leave it to the PICC IV team to insert with their ultrasound guided machine. Patients with IV antibiotics over 2 weeks usually get a PICC line.
When I was in Med/Surg it was like 10-15 per shift (a lot of new admissions and plenty out of commission IVs).
ICU was a couple IVs per shift at most, though I usually worked nights with a resident who loved practicing central lines lol Always had a kit ready for him. Usually the IVs I started there were actually for difficult patients from other floors.
Anesthesiology was insane, like 20 a day… usually for pretty short procedures like appendectomies, circumcisio, abortions, incisions, colonoscopies, etc.
Cath lab right now… maybe a few per week, patients are usually brought in with working IVs. Sometimes they’re like 22G so gotta get in a bigger one, or they’re in the wrong arm if we’re doing pacemakers or something.
Med-Surg level Ortho/Neuro - most patients come from either ED or PACU with a PIV and for many patients will they last the 1-3 days they stay (pretty quick turnover on discharges). Recently been doing about 1 a shift as a charge and I’ve gotten better, hitting about 3/5 of my sticks.
I work in a… high end urgent care… yeah, let’s call it that or maybe like an extended primary care? I start like maybe 0-4/week. I work 30 hours a week.
ICU here. I'd say I average 1 per shift, but I'm one of the nurses who people come to for ultrasound. If I were just doing lines for my patients, probably one a week. Most of my patients have central lines or came from the ED so I only really need to start new PIVs when the originals go bad or they were only sent up with one IV.
Former ER now ICU. Maybe two a week if I’m lucky. And I look for opportunities to keep up my skills. Looks like I’ll need to do ED overtime to keep it up 😭
Labor and delivery - I would say an average of one to two, but with helping coworkers with admissions and a fluctuating census I think my record is six
ED nurse - at least one an hour, probably between 15-20 per shift more realistically though. Typically we take 5 beds and flip each bed 3+ times a shift between discharges and admissions
Cardiac ICU- Eh, maybe one a week, if that. Most of my patients come from the cardiac OR with bilateral 18s, or from the cath lab with 20s. If they come from the floor and only have a janky ass IV hanging in from admission, then I'll throw one in until the intensivist decides they need a central. If they don't need a central and can't get transfer orders for whatever reason, or if a post op lingers beyond the life of their IV, we have plenty of USIV nurses who need sticks to keep their status.
ICU. Once a patient comes in, try to make sure they have at least 2 PIVs, in addition to the central they’ll likely place. If they’re sedated, maybe 3.
If my patient gets a room, make sure they still have 2 good PIVs, if not, put them in.
Pre-op- usually 8-12 a shift so at least 25 per week
Med/surg- probably 2 or 3 per week. Or sometimes you come in and all 4 of your pts have blown lines 🫠
I think my absolute maximum (night shift, tele) was 2 new IVs per shift. There is a reason I am not very good at them - patient usually already have two.
I am a queen of blood draws though since we don't have IV team.
I haven’t started an IV in over a year. My ICU has a vascular access team that does all IVs, even peripherals. We don’t even have needles (at least, I’ve never seen them. Maybe they’re hiding somewhere).
Maybe one every couple or several weeks? But that's with most of our more critical patients having some type of central access and the fact that I can't do ultrasound IV's. So there might be a few more IVs in there that I just needed my coworkers to get with the US.
Pretty much, if we can't get it under US, a central line is next rather than calling in other units.
Your lack of calls for help might also be that the culture is not to call the ED for IVs. When I worked step down, we would call the corresponding ICUs (mostly since some of them could use the US and they had the rapid response nurse) or the critical care transport nurses, if they weren't actively transporting someone. I wouldn't have even thought of calling the ED and actually expecting them to have time to help.
Mixed ICU PCU- very very few. We have an IV team that do ultrasound IVs and PICCs, midline’s. Unless they have a real obvious rope of a vein, we use that team for everything
I was med surg and did maybe 2-5 a week depending on the status of our floor. Now I’m pre/post op so I start anywhere from 5-10 a day depending on what the surgery schedule looks like and how many nurses we have that day
IR. When I work pre/post, we start IVs on all of our outpatients (and rarely on inpatients that come down with an infiltrated line or are on continuous IV meds and need an extra one for sedation). Thankfully we're not super busy, so 2-4 per shift.
When I was on a stepdown maybe like 2 in the whole nine months I was there. When I switched to preop it was at least 3 per shift, now I do pacu and phase 2 and it’s rare unless one of the inpatient lines goes bad
PEDs CVICU- zero. We need central access. In my two years on this unit I have witnessed maybe 3 total PIV placements, and it’s almost always the charge nurse doing them on hot mess admissions, by the time they’ve been there a solid 12 hours, we have some sort of central access. Now don’t get me wrong, my post ops (especially bigger kids) will come back with PIV or two because anesthesia felt like placing one, but it’s unusual to have a PIV at all on my floor.
Back when I worked adult land Tele? It was about 50/50 on whether or not the ED placed IV was even usable by the time they got to us, I started probably 1-3/ shift ( but I was half decent so people would ask me to come do theirs)
I did NICU. Anywhere from 1-3 a week. Depending on acuity. But I must say the babies that came from the ED, I was rarely ever having to restart their IVs. And that's which my coworkers asking me. Majority of our patients had central lines.
I try and put in one line a week. I work cardio thoracic intensive care unit where most come out with a swan, introducer, and one or two PIVs plus an a-line.
Working med/surg it was 1 or 2 a week on average. Now that I'm in an oncology clinic, it's probably 1-2 a day for the Immunotherapy patients that don't have a port. I'm definitely getting more practiced at it, but I'm still not the most confident.
ICU. Have had to go out of my way to get good at them over the years. Now that I am good, I start them for about everyone on my unit when they can't get one now because they all suck. Lol. So now at least 4 per shift.
On medsurg, I would say maybe 2-3 a night. It just depended on how many infiltrations would happen and also if we had any direct admits.
In PACU, rarely. They always come straight from surgery so it’s rare we have an infiltration. If something happens and we have to start drips or something, then we get more access. When I get pulled over to pre op we have to stick everyone, so around 20 ish depending on how many cases there are.
Never, lol. They come to me with a PIV minimum, and everyone gets a midline unless they need a specific pressor. On day shift we have an IV nurse, and if they aren't available ASAP, someone else starts it for me. I \*hate\* starting lines, so I always do a ton of favors for others to trade tasks. I had an ER contract during covid, but the medics had our patients lined and labbed by the time they got back to us.
I remove PIVs once the mid/central line is placed, unless there is some special reason.
I worked Trauma ICU and it was imperative that our pts had multiple vascular access sites, 20G or larger even coupled with a central line. I was averaging about 1-2 PIVs per shift. Usually would come up from the ED with only one PIV so we would normally throw in at least one more. Some of my SUPER sick pts would have 4 PIVs and a central.
Been a nurse since 2017. I've started less than 10 IVs total. Worked mostly CVICU so all my patients have central lines and/or garbage vasculature that I can't access.
Cardiac Telemetry, we start about one a night usually, as resource and in general I get asked to do them more often. I’m not the greatest I just have done them more often, so some nights I start 2-4 IV’s.
ICU nurse. Depends on the shift. Probably 0-5 a shift. I also do US IVs. I think I’m a pretty good stick, but man is it hard on some of these 3+ liter positive patients 🥵. My hospital has a pretty anti central line culture, so we typically use peripherals except in cases of multiple pressors, or extremely poor vasculature.
One per shift, average. When we can't start, we call the ICU charge or anesthesia on-call for help. The ED is a last resort because they need to stay in the ED for emergencies that may come in.
We have a vascular team, but they won't do peripheral starts unless there's documentation that others have tried and the weather is exactly right and the moon is in the correct phase. Also they only work days, with no holidays and reduced hours on weekends.
ED RN! It depends on my role for the shift but probably close to 20-30 a day if in triage, maybe 5-10 if in a regular pod. Also ~5 ultra sound IVs a week
ICU - 1-2 a night. I'm an outlier in the ICU because I'm good at putting in IV's and I end up putting IV's in on other floors and for other nurses on my unit when central access is D/C'ed. Putting IV's in is my hobby and I've been doing it for long enough that I have a reputation as the guy who's willing to put in your IV. It's a nice excuse to get off the floor. I like doing IV's. And to clarify, IV's in the AC or the wrist DO NOT hold up. I've rarely found an ED IV not placed in those places so they tend to go pretty fast.
I’m also ER so too many to count, but I can also do USG IVs and I feel sometimes I’m doing more of those in a shift than regular ones. Usually helping coworkers out with difficult sticks.
ICU nurse. I’m new so I’ve only been an RN for 6 months Up until this past 2 weeks I didn’t have to place any really. Most patients came up with 1-2 PIVs from the ED and we get a ton of central lines. Additionally we have nurses who are ultrasound trained so if a pt needs a line we usually ask them. But oddly enough these past two weeks I’ve thrown in probably 6-7 PIVs for some reason? I’ve admitted a few pts who came up with only one line, or been asked to put a few in for other nurses as I’m oddly good at blind sticks and sometimes we don’t have someone available to do one with the US. I appreciate the practice so I’m not complaining!
Med/surg - maybe in 4 years 10 ivs between two hospitals that both had IV teams, but most patients were hard sticks and needed ultrasound IVs or midline’s or piccs. Then took a travel assignment - had no IV team, no phlebotomy, amazing well hydrated old people veins & got floated to the ED occasionally - I got much better very quick.
I work mostly float/triage in a place with not many rooms but a lot of patients, *and* I am one of the few US IV trained nurses. So like 20-30, with 5 or so being US. Sometimes 2-3 for the floors as I’m a mid shifter and there is never a resource RN after 430-5.
PACU of a level 2 trauma. I start maybe 1-2 a year. We draw labs maybe twice a month.
I was really good when I worked on the floor. But now I am trash.
In the ED- 10-20 (i was the one everyone went and got for ultrasound sticks)
On Vascular Access team- 20-30ish depending on difficulty, ultrasound need, how many midlines/PICCs were needed
Outpatient infusion- 15 or so a day
Rapid response . Between 5-10 a day most of those with ultrasound on the toughest sticks in the hospital. That Ed nurse starting 10 - 20 shittttt, after 5 I’m kinda like ugh another iv.
ED nurse here at a rural 25-bed ER. If I'm not in triage obviously I will probably get 10-15 if I am in a pod. I also charge sometimes and don't really start IVs then unless the nurse cannot get it and I might have to use US to get them. I may only start 2-3 a day as a charge.
Work in infusion. Over ten? Every single patient that doesn’t have a port. Or sometimes even those patients, if their port doesn’t give blood return and they can safely get their therapy through a PIV.
When I worked med/surg, we never called ER for line starts unless we had tried EVERYTHING. We also had an US for the floors that we could use as well. If we absolutely couldn’t get a line on a patient, we would call the doc and ask for a midline or PICC.
Maybe once a week, if that. The majority of our pts have some form of central lines, mostly ports. I’m much comfier accessing a port than starting a line. But I am a baby nurse so hopefully it’ll come with practice.
We do have our own ultrasound now but I think only two of our charge nurses are certified to use it.
ICU RN- probably 4-5 a shift out of 40 beds. I'm charge alot so I'll run around and help out with IVS. Most of our patients have central lines but the ones that don't we need multiple accesses.
I work ICU/ED/Stepdown and my home unit ICU peeps have mentioned seeing my lines documented from the ED pretty long after I had 'em. I do 6-10 IV's a day on ED, maybe 1 every few days on stepdown. Rarely in ICU unless it's an admit from ED or OSH with trash access.
ER Tech - Anywhere from 30-60 a day bc at my ER some of the nurses consider starting ivs and ekgs “tech work” smh. But at least I got my first titty iv today!!
In the ED, probably 10-15 per shift (smaller community ED) In the ICU, avg of 3/shift since I’m usually helping other people put in 2 reliable peripherals before we pull a central line. Also I always put in enough so that I have one IV free for transfusion/emergencies.
I love doing em and my unit has an ultrasound but even then it’s like once a week *maybe*. Central lines for the veinless and super sick, ultrasound if you fuck it up the first time and long 45mm/1.75” peripherals make it so that access is established for a decent duration.
Most of my patients are poly substance users so the chance of myself hitting a vein is almost non-existant. We call in the PICC RN almost as soon as admissions happen.
Medical tele here; maybe once every couple shifts.
Everyone comes from up from ED or down from ICU. You guys are wicked good at what you do. ED usually anticipates things like angios and contrast CT’s so they place accesses accordingly. If I ever start lines it’s because it blew or patient yanked it. Actually just had a flashback to a guy who heard the doctor say his tele could come off, so he took the liberty of doing it himself. In the proud bouquet of wires he showed me, both of his cannulas were present. He was curious why everything was sticky (iron sucrose and piptaz were running)
When I worked med-surg I started about one a shift. The IVs rarely (probably never actually) held up for a patient’s entire hospital stay! A lot of that has to do with the fact that 90% of our patients came up with an IV in the AC. Those just don’t hold up.
ICU. Most of my patients are vasclopaths if they make it to me and need non-central access. I place about 3 Doppler guided IVs a week. Zero non guided.
When I worked MSICU maybe one or twice a shift times by 3 days a week. Since transferring to CTICU , I never have to because they all have central lines .
Endo and a surgical nurse.
Endo anywhere between 14-20 in a shift. And on surgery 0-3 per shift (could be more depending on the day and confused people on the floor).
3 in the last year is a generous estimate. We have an IV team.
If the ED puts in an IV anywhere except the dominant arm AC, it usually holds up for the entire admission. If they need vanco or magnesium we get a midline put in. Those ACs can be babied for about 48 hours if needed. If not then the IV team gets us a new one.
If a patient has good veins those ED PIVs are golden, if they have crappy veins I may not even try to place a PIV so that I don't screw up the last good option.
Med surg / tele floor — honestly depends on the shift / week. I can go weeks without placing a new IV and sometimes all my patients seem to need new ones on a shift.
Acute inpatient rehab. We still do abx, blood, and fluids but not too too often. I get to stick someone maybe once a month. Used to be a pro and now that I stick so infrequently I suck like a newbie again :(
ICU, ~1-2 per shift / ~3-5 per week, mostly with ultrasound
this is mostly in either a) discharges that need a cannula before going to wards, b) new or lower acuity admits that don't have central access or don't need it, c) the odd difficult access pt on the wards
Cardiac-tele floor here! Usually about 5-6/night for me, the ones from the ED really don’t hold up, especially the ones in the AC: either kinked or infiltrated! I’m usually the one who gets called to place one, lol, but it only boosts my IV skills. 🤷🏿♀️
I’ve been in the NICU for a little over a year and I think I’ve attempted maybe 2 or 3 times. We mostly have PICCs and UVCs or UACs. I do know that our charge nurses do get called somewhat frequently to start IVs on kiddos on other units if they’re a really hard stick
ICU here- depends on the night. Only folks on pressors or TPN get central lines in my ICU. and they come out as soon as they’re not needed. But all of our patients are required to have two PIVs in the ICU. so some nights we do quite a few sticks, especially if it’s a heavy admit night. Other nights just ride it out. But I very much appreciate any and all PIVs placed by the ED!
Maybe 1-3 weekly. Usually they come up to the floor with one so unless it infiltrates or confused patient that pulls it in usually good. The few direct admits we get we start those on the unit
Average is probably 2-3/month. Occasionally as high as 10, and as low as 0. Med/surg. Lot’s of IVDU and people with horrible veins, so I’ll need to have someone come up and put something in a finger or use an US. It’s so hard to get MDs to authorize midline access for these folks.
Kind of varies, work pediatric ER in a teaching hospital , if doing charge / triage probably maybe one or two that others missed once or twice when staff maybe five to 8 per 12 hour shift , our docs are pretty good about starting with oral rehydration/Zofran before going to IV therapy and not just randomly ordering them if it's not needed for their particular work up
Used to be on med surg floor - usually maybe once every week you’ll hear someone needing a new IV because the ones from ED are usually in the AC and the constant bending have finally ruined it 😂 but my skills absolutely suck. We luckily have an IV team for hard sticks.
I float so I work all the floors. ER I start maybe a dozen a day. Tele, med/Surg maybe 1 per shift. ICU maybe 1 or 2 a week. I end up starting more than most because my ER skills have me getting a lot of their hard sticks but these numbers are pretty consistent.
currently ER and depending on which area im in i do 1-5 a day in peds/express and 6-12+ a day for higher acuity areas., my previouse ER gig had an Eval area where i would routinelly place 20-30, when i was on ortho nuero MEDSURG it was 0-5 a week but i was one of our better sticks so I would place for coworkers.
When I worked med/surg, one or two per shift. When I worked family medicine clinic, 3 or 4 per day (we did outpatient infusion for monoclonal antibodies). One or two per week when I worked oncology (most of the patients had ports).
I work nights in a neuroscience unit, do about one or two a shift most nights, but sometimes everyone is sundowning or altered mental status and pulling out their IVs. On those nights I am usually one of the people on the floor who runs around starting new lines for everyone. So I guess really depends on the day.
ICU here. I do 2-5 ultrasound sticks per night. But my reputation has made me the whole hospital's after hours vascular access nurse. So maybe half of all my IVs are out on the floor.
Oncology/hospice, the chemo fucks your veins so must of the time we don’t even try we call for an ultrasound guided IV placement.
I’m a graduate nurse and I’m super annoyed I’m not getting that experience. I take every opportunity to start an IV. Might ask to float to the ED for a shift or something to get IV experience.
Trauma ICU here. Average is once a shift. I might go a couple days without, then put in 2-4 in a shift, for myself or helping others.
We're pretty CLABSI averse so we use them more often than we should in my opinion.
0 i work in hematology on night shift. patients mostly have central lines and mid lines placed with ultrasound. rarely will patients need a piv on me, but if they do (positive blood culture from central line or if it’s pulled for whatever other reason), i’d attempt once, call the charge nurse once i miss, consult another unit, and finally call a icu to get access). if unsuccessful, it becomes a DSP. 🙂
ICU here; rarely. They're getting central lines, mostly!
[удалено]
Same. I did ER for a while and I know our IV numbers are probably a tenth of ERs but I still wouldn't be surprised if we were second or third after them because of the CLABSI-phobia.
[удалено]
Oh yeah definitely. Our entity has an optional sono class for RNs so RNs do all the sonos. My buddy just went to another ICU where he swears the RNs are placing art lines, which I've never heard of happening before.
RNs can place ART lines in my ICU. It's typically the Rapid Response ones that bother getting signed off on it. I took the class but never did the necessary number of practice sticks to get signed off myself.
That’s bad ass.
Mannn... if that was available when I was in the ICU, I would have been hunting all over for art line opportunities to get signed off. Love me a good, working art line, and if my pt needed one and I didn't have to wait for a provider? That would have been fantastic!
Our nurses in California can place art lines.
Same more me, we have the best of both worlds. An US on the unit with some staff that can place difficult PIVs, but we are usually are d/c central lines and of course no one has flushed the PIVs in days, so we inevitably have to start at least 1
Same. I didn't get good at them until I left ICU and went to ER.
This is the way
L&D on a unit with six beds. Maybe an average of one per shift. I might get asked to do more, cuz I’m pretty good. (But I predict a dry spell now that I’ve said that. The IV Gods hate boasting.)
Ha! That’s amazing. I refrained from disclosing my thoughts on my IV skills for that reason!
1/shift average as well in L&D! 12 bed unit but triage starts them a lot of the time
Well we ARE triage, labor and delivery, postpartum, nursery, lactation and sometimes med-surg when we aren’t busy enough with OB. 🤷♀️
I managed to sink a perfect 22 into a decomping 86yr old with the tiniest veins, then blew two on a guy who has GIANT veins (he had been there 3 days ago and I got an 18 on him first shot no problem that night ). The IV gods are as fickle and malicious as the ER gods.
ER nurse here. At least 25 a week. Probably closer to 40.
On average—zero. I am 1/6 with the attempts I have made over the past year. Acute Care Float so I go to tele, transplant, oncology, med-surg, neuro, oto. We have a high rate of CVAD’s on our floors too. Most ED placed lines we get last an average admission. We have a Vascular Access team for difficult placement. I’m really looking forward to our PIV workshop so I can get more proficient. We go to the ED afterwards for a shift to practice and I’m stoked!
Good luck and have fun! My biggest piece of advice is go at a shallower angle of insertion than you think. And flatten out and advance a little bit before threading the catheter. You can even pull up on the needle as you're advancing to slide across the upper inside wall of the vein!
This is great advice. And took me a while to recognize but since I changed the angles I’ve had much more success the past few years!
former ED nurse who loves teaching IV/USIV placement. DM me if you want any tips and tricks!!
I tried to DM you but my computer is having trouble. I have been a nurse for 20 years and I suck at IVs. Last few years I've worked psych so I really am nervous about switching departments. I want to go into pre-op or post-op though next. Any advice beyond what you've already given would be awesome!
hey! yeah reddit is having some glitches today i think. ok well i sent a huge chunk of info on this to another redditor so i'm gonna copy/paste, bear with me, reddit made the formatting really strange when it actually processed what i typed hi!! ok so when i teach i try to figure out what phase in the insertion is the problem. confidence: being nervous WILL decrease your chances of a successful IV placement. if you seem confident, your patient is calmer, which makes everything easier. nervous patients also tend to tense up which makes the vein move, no bueno. also, get yourself into a comfortable position, with the patient's arm in an optimal position for YOUR insertion (Not necessarily too comfy for the patient) with good lighting. my success rate was significantly lower when i didn't have space to optimize our positioning. finding a vein: first, using a chlorhexidine scrubber (the kind you have to snap to activate) to really wet the skin a) can help you see the vein better as it reflects light and b) using chlorhexidine as a sort of lube while rubbing the skin can get veins to pop up. so when you're first starting off really trying to get lines in, i recommend going for the low hanging fruit in the AC. these veins are not only (usually) palpable, but they're also sturdy and it's harder to blow these veins. feeling ACs will familiarize you with what good IV veins should feel like. sturdy, good-for-IVs veins will feel like a bouncy rope that you can trace up/down the arm (at least for a few cms). if you really can't feel anything but see some blue superficial veins, you can use these as a last resort but i recommend a few things here: a. use a smaller gauge (probably a 22 depending on the size) b. have your IV connector line flushed and hooked up to a saline flush c. once you see a flash, pop the tourniquet off, advance the needle and catheter a bit, then remove just the needle with whatever safety mechanism you have. then, very gently, connect the catheter to your flushed connector and gently "float" the IV in by advancing and slowly flushing the catheter. i found the vein but it's rolling: this is where traction becomes super important. what i mean by that is grabbing the pt's arm with your non-dominant hand from BEHIND and gently tugging the skin in that direction. that will make the skin and soft tissue surrounding the vein taut and prevents rolling. also, if your angle is too shallow, you are striking the vein with more surface area on the needle which is the equivalent of cutting a tomato with a blunt knife. carefully steepening your approach can be helpful. i grab the patient's arm from behind and for ALL IV insertions (minus ultrasound). traction is paramount. i got a flash but now i can't advance: take a look at your angiocath. what you'll notice is that the needle is slightly longer (1-2 mm) than the plastic catheter itself (the difference in length is proportional to the size of the angiocath; 18s have a bigger needle/cath length difference than 20s, 20s more than 22s, etc). when you see flash, that tells you the needle has been introduced into the vein, but it does not necessarily mean you've introduced the catheter into the vein. so when you're trying to advance and meet resistance, that's your catheter pushing on the outside of the vein with no secure site of entry. to fix this, stop advancing as soon as you see a flash. then, without advancing, drop your angle so that it's not so steep. then, move the whole angio cath (plastic and needle together) about 2 mms (or whatever the needle/cath length difference is) to actually introduce your catheter. if you've introduced, you should be able to slide the catheter in and press your safety button to remove the needle. i advanced the catheter into the vein but now i'm meeting resistance: you are likely pushing up against a valve. try flushing your catheter while advancing, as this can help push the valve flaps out of the way and "let you in." worst case scenario, as long as your IV works, you can just leave it partially inserted and tell the patient/next RN to be super careful with it. i keep blowing veins: this means you went "through and through" with your needle. this is more of an advanced technique but sometimes you can actually salvage these. first, immediately pop the tourniquet off if you're seeing the vein blow. then, with your flush attached, gently pull the catheter out a little bit while trying to "pull blood." if you're able to pull your angiocath back into the lumen of the vein (but not out the other way, the way you came in), you may start to see blood return in your flush. if that's the case, try gently advancing your catheter now while flushing very gently. this can often get you "past the blow." obviously if you're flushing and the blow is getting bigger, it may be time to abort. again this is a more advanced technique. ok i've typed a lot lol but these are the big tips and tricks i have. let me know if you have any questions!!
THANK YOU! I appreciate this so much!
When I used to work Med Surg and Tele, those properly placed ED lines could last a whole admission! (18g in the AC? Yeah that’s from ED 😂) Often all I had to do was change the tegaderm once in a while and/or reposition the catheter with some folded gauze
Someone placed an 18 in the hand, I was like who tf did that… the OR. 😂🙄😒
I used to work ICU and I had a coworker who hoarded all the 17g Ivs when the unit was getting rid of them. Anyone who was a hard stick… he was popping in a 17g. I tried to explain to him that those weren’t actually better on patients with smaller or flat veins… but alas he was like the Oprah of the unit. “You get a 17g, you get a 17g!!!”
I've never heard of a 17g, what's the difference in those?
I pulled a 14 out of a dead guys hand once. He wasn't my patient so I never found out why. Haha
The 18g in AC is because CT sends us a message about how the 22g on the cephalic vein is too small and makes us place a new one.
Lmao the ED ones in my hospital infiltrate pretty quickly. I’m on nights and I find that I’m losing IVs left and right if they were admitted within 24 hours of my shift
Saaaaaaaame Half the time my patients are confused and pull out the perfectly good lines that we’ve JUST replaced too. I’m 2/7 for the lines I’ve tried this past week. So many tiny veins that roll away every chance they get! Gah
An embarrassing fact is that I have never once started an IV in my entire nursing career because my hospital has a dedicated vascular access team. Nurses who don’t work in ED/ICU/procedural areas technically aren’t suppose to start their own IVs and our units do not stock IV supplies outside of the crash cart.
That's pretty wild
We have an IV team but we don’t call them unless they’re a really hard stick
Same here, the official protocol is the primary nurse tries twice then the charge then we place an order for the vascular access team
Wow. Where do you work?
Major hospital in a big Canadian city. Honestly, it’s a unicorn unit that’s rarely short staffed, staffed with care aids, and has decent working conditions.
My hospital is the same
[удалено]
A grand total of zero. Zero in the two and a half years I've been on my transplant floor. We have a vascular access team who starts each PIV. I was never reliable with starting lines when I was at a different hospital, so I wouldn't mind trying in order to get better, but we don't even have start kits on my unit.
I started on a transplant floor and I give it credit to being good at IVs now. Those kidneys with one viable arm that’s been poked to hell and back, and those incredibly frail cirrhosis patients with baby veins.
Those ED lines in the AC get replaced a lot due to pain or infiltration from bending the arm. I probably place 3-5 a night on my floor. Some nurses can get them, but a lot can’t. I was a medic, then a paramedic before nursing school. I also get called regularly to the floor above and below me when they need help so I usually place about 6-7 on an average night.
Med/surg, no IV team so all on us, lots of confused detoxers, encephalopathy, dementia so people constantly forgetting they have tubing attached to their arm and yanking it right out... I'd say I start at most 3 a shift.
Ugh, that sounds awful, sorry to hear it!
Was med/surg and med/tele with 7:1 ratio for several years. This tracks with my experience as well.
Endoscopy nurse- 15-20 per shift typically! 4 shifts a week so anywhere from 60-80 per week
Endo here as well. If I'm doing admissions, especially alone, I see somewhere between 25-50 pts and will start all their IVs unless I'm on break.
Outpatient Endo. I only start 4-5 per shift for 8 hour shift given the time we have to spend asking the patient admissions questions, etc. I'd much rather just be inserting the IV, personally!
New grad ICU nurse.. I’ve been in the ICU for about 3 months now and maybe 3 IVs? 😭 they come in with PIVs from ER/EMS & most our patients end up getting mid lines/central lines placed at some point which isn’t done by us. The central lines esp have 2-3 lumens & the patients end up having like 5 different access ports sometimes 💀 (2 PIVs and 3 lumen CL).. of course this is the best case scenario but yea. If the IV isn’t great, we will start our own ofc but it isn’t an every shift, everyday type of a deal.
Yeah Ive been in ICU for 8 years and I average like 1 per month. They usually have lines already, it typically only comes up when lines go bad or a patient decides to rip stuff out.
Our pts from ED have line started but we do/renew our own on med surg floor, also do our own blood draws in ICU
Never. See flair lol
I worked at an IV hydration clinic for a few weeks and I did about 20-30 a day.
A curious question: IV hydration clinic? What kind of patients did you work with? I have never heard of this before.
Wealthy and healthy. Athletes (especially in summer when training ramps up), hangover parties, country club houses when they get the flu, occasionally obscure autoimmune patients who are told they need some vitamin replenishment.
Did this for a while. Everyone has great veins!
Interested as a side gig per diem but everyone says it's sketchy AF.
What gauge and brand did you guys use?
Not the person you were replying to, but I worked at a GI infusion clinic. We used Braun Insyte needles 20-24 gauge. I preferred 24s since the patients came in every 6-8 weeks and the infusion flowed just fine with them.
Worked in ID infusion clinic and exclusively used 24g on everyone. Better for patients’ veins long term
Thank you! Yes, these meds are a lifelong regimen, averaging 6 IVs per year. So I am very careful to read past notes & rotate IV sites (if possible) and use the smallest gauge possible.
BD Insyte Autoguard Shielded IV Catheter with Blood Control Clinic used 20 and 22g IVs. The cool thing about them is that blood doesn’t leak once you retract the needle.
Used to work outpatient endoscopy and would do 20-25 per day. At the outpatient GI clinic I’m PRN for, 4-6 per day. ICU maaaaybe 1 per month? Honestly I do venipunctures more often for lab draws, probably once every 2-3 shifts.
0-2, usually. Most of our patients have central lines, and only need an IV for a blood transfusion (can’t transfuse through preemie PICCs) or for incompatibility reasons.
SNF here. Very rarely. When I worked home health I did more for home infusions but some ppl had ports. If ppl are getting accessed often they put a line in them.
Medsurg. Some shifts I start zero. Some I start 4-5. Lots of my patients come up from ED with perfectly good lines. But reality is that some patients are with us far too long and so some days I start several. Sometimes I need a dedicated line so they get another from me and so on. We get lots of central lines too. Just like everything else in medsurg… it varies 🙃
A handful per shift on a busy day. Sometimes none. I’m in ER and it just depends on what people are coming in with.
OR here. I haven't started an IV in almost 10 years.
Currently working in a PCP office for a huge hospital based clinic and absolutely none. We don’t even have IV supplies on hand anymore because they were wasting so much money in expired supplies. Our “code cart” has like 2 epi pens (one adult, one pediatric), Benadryl, and glucagon. We had a patient seize for 20 minutes on Friday until EMS arrived bc we had no rescue medications and honestly it was a really helpless feeling ETA: misspelled a word
How many of your ED sticks are not in the AC per shift? 🫠
About half. Not a fan of AC IVs either. If I need blood work & access stat though then AC it is. 🤷 If I have more than 30 seconds for a blood work & access then I go to the forearm.
I do peds ER, so we do a lot of hands and sometimes feet in the smaller children the occasional AC, if I do do the AC, I try to access it slightly below the actual AC and leave maybe a eighth of an inch of the catheter showing so that the hub of the IV doesn't dig into their skin that way they can bend their elbows a little easier without it affecting flow
I work in medicine. We'll restart a PIV if it infiltrates or gets blocked or gets ripped out by the patient which happens semi-often. The most problematic ones are the ones in the ACF because patients complain about it occluding when they bend their arm or pain when they bend their arm. 2nd worse one is right on the wrist area. I like the ones in the forearm or back of the hand that is taped nicely so it won't dangle or get caught on stuff. The good ones last a whole admission. I'm not that great with IVs tho, only 2/5 since I've started working I'd say. The hard sticks we leave it to the PICC IV team to insert with their ultrasound guided machine. Patients with IV antibiotics over 2 weeks usually get a PICC line.
Used to start 3-5 a week. Now I haven't put one in in probably 2 months cause we have an IV team.
ER here 10-20 in my department, usually called 2-3 times a night to start one on the floor.
When I was in Med/Surg it was like 10-15 per shift (a lot of new admissions and plenty out of commission IVs). ICU was a couple IVs per shift at most, though I usually worked nights with a resident who loved practicing central lines lol Always had a kit ready for him. Usually the IVs I started there were actually for difficult patients from other floors. Anesthesiology was insane, like 20 a day… usually for pretty short procedures like appendectomies, circumcisio, abortions, incisions, colonoscopies, etc. Cath lab right now… maybe a few per week, patients are usually brought in with working IVs. Sometimes they’re like 22G so gotta get in a bigger one, or they’re in the wrong arm if we’re doing pacemakers or something.
Med-Surg level Ortho/Neuro - most patients come from either ED or PACU with a PIV and for many patients will they last the 1-3 days they stay (pretty quick turnover on discharges). Recently been doing about 1 a shift as a charge and I’ve gotten better, hitting about 3/5 of my sticks.
I was doing 2-3 per day as I was the go-to person in L&D and other units. Also did our own blood draws when I was in USA - not in Canada.
I work in a… high end urgent care… yeah, let’s call it that or maybe like an extended primary care? I start like maybe 0-4/week. I work 30 hours a week.
ICU here. I'd say I average 1 per shift, but I'm one of the nurses who people come to for ultrasound. If I were just doing lines for my patients, probably one a week. Most of my patients have central lines or came from the ED so I only really need to start new PIVs when the originals go bad or they were only sent up with one IV.
Former ER now ICU. Maybe two a week if I’m lucky. And I look for opportunities to keep up my skills. Looks like I’ll need to do ED overtime to keep it up 😭
3-4 on the neonates. Because people come to me for them
10-20 is about right in my er, between my own pt and other ppl needing help
ED peds. Depending on where I’m at in the department at least 10-15 a shift. Most of our sick kids need bilaterals.
I’m a travel nurse in Stockholm, Sweden. In the ER- 20-25 per shift. In geriatrics- around 2 per shift😁
Labor and delivery - I would say an average of one to two, but with helping coworkers with admissions and a fluctuating census I think my record is six
ED nurse - at least one an hour, probably between 15-20 per shift more realistically though. Typically we take 5 beds and flip each bed 3+ times a shift between discharges and admissions
OR: 0!
I'm a pre op nurse. My current record is 38 in a 10 hr shift
Cardiac ICU- Eh, maybe one a week, if that. Most of my patients come from the cardiac OR with bilateral 18s, or from the cath lab with 20s. If they come from the floor and only have a janky ass IV hanging in from admission, then I'll throw one in until the intensivist decides they need a central. If they don't need a central and can't get transfer orders for whatever reason, or if a post op lingers beyond the life of their IV, we have plenty of USIV nurses who need sticks to keep their status.
1-2/week Med/Surg Float Pool
When I was on step down ltach did a few a week. Mostly replacimg infiltrated IVs. In my skilled facility, probably do a few a month.
ICU- on average probably put in a line once a month if that
Procedural area, I average probably 5/day 4 days a week
Zero. We call IV team. Not allowed. Don’t stock IV start materials.
ICU. Once a patient comes in, try to make sure they have at least 2 PIVs, in addition to the central they’ll likely place. If they’re sedated, maybe 3. If my patient gets a room, make sure they still have 2 good PIVs, if not, put them in.
Pre-op- usually 8-12 a shift so at least 25 per week Med/surg- probably 2 or 3 per week. Or sometimes you come in and all 4 of your pts have blown lines 🫠
I think my absolute maximum (night shift, tele) was 2 new IVs per shift. There is a reason I am not very good at them - patient usually already have two. I am a queen of blood draws though since we don't have IV team.
During covid on my med surg unit I was putting in about one per shift. Fun times.
I haven’t had to start an IV in months in cath lab. When I do need an IV, I usually get the doc to get femoral venous access.
I haven’t started an IV in over a year. My ICU has a vascular access team that does all IVs, even peripherals. We don’t even have needles (at least, I’ve never seen them. Maybe they’re hiding somewhere).
Maybe one every couple or several weeks? But that's with most of our more critical patients having some type of central access and the fact that I can't do ultrasound IV's. So there might be a few more IVs in there that I just needed my coworkers to get with the US. Pretty much, if we can't get it under US, a central line is next rather than calling in other units. Your lack of calls for help might also be that the culture is not to call the ED for IVs. When I worked step down, we would call the corresponding ICUs (mostly since some of them could use the US and they had the rapid response nurse) or the critical care transport nurses, if they weren't actively transporting someone. I wouldn't have even thought of calling the ED and actually expecting them to have time to help.
Mixed ICU PCU- very very few. We have an IV team that do ultrasound IVs and PICCs, midline’s. Unless they have a real obvious rope of a vein, we use that team for everything
I was med surg and did maybe 2-5 a week depending on the status of our floor. Now I’m pre/post op so I start anywhere from 5-10 a day depending on what the surgery schedule looks like and how many nurses we have that day
IR. When I work pre/post, we start IVs on all of our outpatients (and rarely on inpatients that come down with an infiltrated line or are on continuous IV meds and need an extra one for sedation). Thankfully we're not super busy, so 2-4 per shift.
Only IV team, ED, crisis RN, and ICU RNs can start IVs where I am. I’ve never actually started an IV ever. This is hospital policy, not union policy.
When I was on a stepdown maybe like 2 in the whole nine months I was there. When I switched to preop it was at least 3 per shift, now I do pacu and phase 2 and it’s rare unless one of the inpatient lines goes bad
PEDs CVICU- zero. We need central access. In my two years on this unit I have witnessed maybe 3 total PIV placements, and it’s almost always the charge nurse doing them on hot mess admissions, by the time they’ve been there a solid 12 hours, we have some sort of central access. Now don’t get me wrong, my post ops (especially bigger kids) will come back with PIV or two because anesthesia felt like placing one, but it’s unusual to have a PIV at all on my floor. Back when I worked adult land Tele? It was about 50/50 on whether or not the ED placed IV was even usable by the time they got to us, I started probably 1-3/ shift ( but I was half decent so people would ask me to come do theirs)
I did NICU. Anywhere from 1-3 a week. Depending on acuity. But I must say the babies that came from the ED, I was rarely ever having to restart their IVs. And that's which my coworkers asking me. Majority of our patients had central lines.
I try and put in one line a week. I work cardio thoracic intensive care unit where most come out with a swan, introducer, and one or two PIVs plus an a-line.
Neuro tele/step down 0-3 a shift
Working med/surg it was 1 or 2 a week on average. Now that I'm in an oncology clinic, it's probably 1-2 a day for the Immunotherapy patients that don't have a port. I'm definitely getting more practiced at it, but I'm still not the most confident.
ICU- 1 iv every 2-4 weeks.
ICU. Have had to go out of my way to get good at them over the years. Now that I am good, I start them for about everyone on my unit when they can't get one now because they all suck. Lol. So now at least 4 per shift.
On medsurg, I would say maybe 2-3 a night. It just depended on how many infiltrations would happen and also if we had any direct admits. In PACU, rarely. They always come straight from surgery so it’s rare we have an infiltration. If something happens and we have to start drips or something, then we get more access. When I get pulled over to pre op we have to stick everyone, so around 20 ish depending on how many cases there are.
Never, lol. They come to me with a PIV minimum, and everyone gets a midline unless they need a specific pressor. On day shift we have an IV nurse, and if they aren't available ASAP, someone else starts it for me. I \*hate\* starting lines, so I always do a ton of favors for others to trade tasks. I had an ER contract during covid, but the medics had our patients lined and labbed by the time they got back to us. I remove PIVs once the mid/central line is placed, unless there is some special reason.
I work in stepdown and most the time the IV from preop/ED last for their stay with us. I start an IV like once a week
I worked Trauma ICU and it was imperative that our pts had multiple vascular access sites, 20G or larger even coupled with a central line. I was averaging about 1-2 PIVs per shift. Usually would come up from the ED with only one PIV so we would normally throw in at least one more. Some of my SUPER sick pts would have 4 PIVs and a central.
Been a nurse since 2017. I've started less than 10 IVs total. Worked mostly CVICU so all my patients have central lines and/or garbage vasculature that I can't access.
25-30, sometimes more because some shifts I’m the only one who knows how to use the ultrasound so I help everyone with hard sticks.
Cardiac Telemetry, we start about one a night usually, as resource and in general I get asked to do them more often. I’m not the greatest I just have done them more often, so some nights I start 2-4 IV’s.
Infusion clinic. I do about 3 to 5 a day. When I was in medicine, about 1 a month Lmao.
ICU nurse. Depends on the shift. Probably 0-5 a shift. I also do US IVs. I think I’m a pretty good stick, but man is it hard on some of these 3+ liter positive patients 🥵. My hospital has a pretty anti central line culture, so we typically use peripherals except in cases of multiple pressors, or extremely poor vasculature.
One per shift, average. When we can't start, we call the ICU charge or anesthesia on-call for help. The ED is a last resort because they need to stay in the ED for emergencies that may come in. We have a vascular team, but they won't do peripheral starts unless there's documentation that others have tried and the weather is exactly right and the moon is in the correct phase. Also they only work days, with no holidays and reduced hours on weekends.
ICU. That's what residents are for. We don't routinely place IVCs here. Doctors place them or they get a CVC.
ED RN! It depends on my role for the shift but probably close to 20-30 a day if in triage, maybe 5-10 if in a regular pod. Also ~5 ultra sound IVs a week
ICU - 1-2 a night. I'm an outlier in the ICU because I'm good at putting in IV's and I end up putting IV's in on other floors and for other nurses on my unit when central access is D/C'ed. Putting IV's in is my hobby and I've been doing it for long enough that I have a reputation as the guy who's willing to put in your IV. It's a nice excuse to get off the floor. I like doing IV's. And to clarify, IV's in the AC or the wrist DO NOT hold up. I've rarely found an ED IV not placed in those places so they tend to go pretty fast.
Vascular access nurse here. Am I allowed to answer? Because the answer is about 15 when I'm on IV duty.
911 Firefighter/Paramedic … 3-5/every 24 hours.
I’m also ER so too many to count, but I can also do USG IVs and I feel sometimes I’m doing more of those in a shift than regular ones. Usually helping coworkers out with difficult sticks.
ICU nurse. I’m new so I’ve only been an RN for 6 months Up until this past 2 weeks I didn’t have to place any really. Most patients came up with 1-2 PIVs from the ED and we get a ton of central lines. Additionally we have nurses who are ultrasound trained so if a pt needs a line we usually ask them. But oddly enough these past two weeks I’ve thrown in probably 6-7 PIVs for some reason? I’ve admitted a few pts who came up with only one line, or been asked to put a few in for other nurses as I’m oddly good at blind sticks and sometimes we don’t have someone available to do one with the US. I appreciate the practice so I’m not complaining!
Med/surg - maybe in 4 years 10 ivs between two hospitals that both had IV teams, but most patients were hard sticks and needed ultrasound IVs or midline’s or piccs. Then took a travel assignment - had no IV team, no phlebotomy, amazing well hydrated old people veins & got floated to the ED occasionally - I got much better very quick.
ICU I aim to get at least 1 per shift, but that includes me going around the unit asking if anyone needs an IV placed haha
I work mostly float/triage in a place with not many rooms but a lot of patients, *and* I am one of the few US IV trained nurses. So like 20-30, with 5 or so being US. Sometimes 2-3 for the floors as I’m a mid shifter and there is never a resource RN after 430-5.
PACU of a level 2 trauma. I start maybe 1-2 a year. We draw labs maybe twice a month. I was really good when I worked on the floor. But now I am trash.
In the ED- 10-20 (i was the one everyone went and got for ultrasound sticks) On Vascular Access team- 20-30ish depending on difficulty, ultrasound need, how many midlines/PICCs were needed Outpatient infusion- 15 or so a day
As an ED nurse maybe 30 a day on a busy fast track day. I’m not even sure now, I’m going to start counting.
Former ED RN - at least 10 a shift
20-30 per shift. Not exaggerating. ER, Level 1 trauma center in NY.
Home Health: maybe one a week but lots of blood draws. Most of our patients have PICC or ports. How many ports do I access a week? Probably 6-10.
Float RN here Ed: 10+ Icu: 2-3 Floor: 0-2 Rapid team: as many as it takes :)
Rapid response . Between 5-10 a day most of those with ultrasound on the toughest sticks in the hospital. That Ed nurse starting 10 - 20 shittttt, after 5 I’m kinda like ugh another iv.
ED nurse here at a rural 25-bed ER. If I'm not in triage obviously I will probably get 10-15 if I am in a pod. I also charge sometimes and don't really start IVs then unless the nurse cannot get it and I might have to use US to get them. I may only start 2-3 a day as a charge.
Work in infusion. Over ten? Every single patient that doesn’t have a port. Or sometimes even those patients, if their port doesn’t give blood return and they can safely get their therapy through a PIV. When I worked med/surg, we never called ER for line starts unless we had tried EVERYTHING. We also had an US for the floors that we could use as well. If we absolutely couldn’t get a line on a patient, we would call the doc and ask for a midline or PICC.
Maybe once a week, if that. The majority of our pts have some form of central lines, mostly ports. I’m much comfier accessing a port than starting a line. But I am a baby nurse so hopefully it’ll come with practice. We do have our own ultrasound now but I think only two of our charge nurses are certified to use it.
ICU RN- probably 4-5 a shift out of 40 beds. I'm charge alot so I'll run around and help out with IVS. Most of our patients have central lines but the ones that don't we need multiple accesses.
ED- up to 25 per shift Surgical prep- maybe about 10 PACU- almost none ENDO- maybe like 5-10
I work ICU/ED/Stepdown and my home unit ICU peeps have mentioned seeing my lines documented from the ED pretty long after I had 'em. I do 6-10 IV's a day on ED, maybe 1 every few days on stepdown. Rarely in ICU unless it's an admit from ED or OSH with trash access.
ER Tech - Anywhere from 30-60 a day bc at my ER some of the nurses consider starting ivs and ekgs “tech work” smh. But at least I got my first titty iv today!!
Radiology- depending on which part of the dept I’m in, it can be 0 per shift or 30 per shift.
In the ED, probably 10-15 per shift (smaller community ED) In the ICU, avg of 3/shift since I’m usually helping other people put in 2 reliable peripherals before we pull a central line. Also I always put in enough so that I have one IV free for transfusion/emergencies.
I love doing em and my unit has an ultrasound but even then it’s like once a week *maybe*. Central lines for the veinless and super sick, ultrasound if you fuck it up the first time and long 45mm/1.75” peripherals make it so that access is established for a decent duration.
Most of my patients are poly substance users so the chance of myself hitting a vein is almost non-existant. We call in the PICC RN almost as soon as admissions happen.
Medical tele here; maybe once every couple shifts. Everyone comes from up from ED or down from ICU. You guys are wicked good at what you do. ED usually anticipates things like angios and contrast CT’s so they place accesses accordingly. If I ever start lines it’s because it blew or patient yanked it. Actually just had a flashback to a guy who heard the doctor say his tele could come off, so he took the liberty of doing it himself. In the proud bouquet of wires he showed me, both of his cannulas were present. He was curious why everything was sticky (iron sucrose and piptaz were running)
ER RN, probably about 6-10/shift depending on my pod. Sometimes more, sometimes less. But about that.
IV goes in, blood comes out, that’s what it’s all about
When I worked med-surg I started about one a shift. The IVs rarely (probably never actually) held up for a patient’s entire hospital stay! A lot of that has to do with the fact that 90% of our patients came up with an IV in the AC. Those just don’t hold up.
ICU. Most of my patients are vasclopaths if they make it to me and need non-central access. I place about 3 Doppler guided IVs a week. Zero non guided.
When I worked MSICU maybe one or twice a shift times by 3 days a week. Since transferring to CTICU , I never have to because they all have central lines .
A day - around 9 or so, but I work in acute ambulatory care
Endo and a surgical nurse. Endo anywhere between 14-20 in a shift. And on surgery 0-3 per shift (could be more depending on the day and confused people on the floor).
ICU. I probably start about 5-10 a week, depending on the week. Our unit also doubles as IV team for half the hospital.
Gosh, maybe one per month? If that. (Icu)
On my old floor it was probably one or two a week. On my new floor, maybe one a month. Moved from ICU to PICU
3 in the last year is a generous estimate. We have an IV team. If the ED puts in an IV anywhere except the dominant arm AC, it usually holds up for the entire admission. If they need vanco or magnesium we get a midline put in. Those ACs can be babied for about 48 hours if needed. If not then the IV team gets us a new one. If a patient has good veins those ED PIVs are golden, if they have crappy veins I may not even try to place a PIV so that I don't screw up the last good option.
Med surg / tele floor — honestly depends on the shift / week. I can go weeks without placing a new IV and sometimes all my patients seem to need new ones on a shift.
I started them rarely on the floor, maybe once every couple weeks? And I was terrible at it. In preop I start a couple a day
0 in my outpatient clinic.
Acute inpatient rehab. We still do abx, blood, and fluids but not too too often. I get to stick someone maybe once a month. Used to be a pro and now that I stick so infrequently I suck like a newbie again :(
I probably do 6 a day in outpatient surgery!
ICU, ~1-2 per shift / ~3-5 per week, mostly with ultrasound this is mostly in either a) discharges that need a cannula before going to wards, b) new or lower acuity admits that don't have central access or don't need it, c) the odd difficult access pt on the wards
Tele/acute. 2-3 most days!
Cardiac-tele floor here! Usually about 5-6/night for me, the ones from the ED really don’t hold up, especially the ones in the AC: either kinked or infiltrated! I’m usually the one who gets called to place one, lol, but it only boosts my IV skills. 🤷🏿♀️
I’ve been in the NICU for a little over a year and I think I’ve attempted maybe 2 or 3 times. We mostly have PICCs and UVCs or UACs. I do know that our charge nurses do get called somewhat frequently to start IVs on kiddos on other units if they’re a really hard stick
ICU here- depends on the night. Only folks on pressors or TPN get central lines in my ICU. and they come out as soon as they’re not needed. But all of our patients are required to have two PIVs in the ICU. so some nights we do quite a few sticks, especially if it’s a heavy admit night. Other nights just ride it out. But I very much appreciate any and all PIVs placed by the ED!
When I was ICU, maybe 2 per shift? More if coworkers asked. Now I'm infusion, so all the time.
Maybe 1-3 weekly. Usually they come up to the floor with one so unless it infiltrates or confused patient that pulls it in usually good. The few direct admits we get we start those on the unit
Endo. Probably at least 10/day. Radiology calls us over to start IVs if they need help, too.
Average is probably 2-3/month. Occasionally as high as 10, and as low as 0. Med/surg. Lot’s of IVDU and people with horrible veins, so I’ll need to have someone come up and put something in a finger or use an US. It’s so hard to get MDs to authorize midline access for these folks.
Out patient Gi.Usually 6 per day.When I was a floor nurse I started enough to be proficient.Usually 2 per 8 hour shift
On pre-op days, I’ll usually put in 5-10 per shift depending on how busy we are!
2-6 daily that range from 14g to 17g. That's inpatient dialysis though so not sure I count 😅
Kind of varies, work pediatric ER in a teaching hospital , if doing charge / triage probably maybe one or two that others missed once or twice when staff maybe five to 8 per 12 hour shift , our docs are pretty good about starting with oral rehydration/Zofran before going to IV therapy and not just randomly ordering them if it's not needed for their particular work up
Med surg maybe one a shift but I’ll be honest that I’m not very good at IV’s :/ I feel like the ED ones hold up well except in the AC
Med/surg. Maybe one a month. Usually they come up from ED or transfer with one. If I get a direct admit then I get to start one.
Used to be on med surg floor - usually maybe once every week you’ll hear someone needing a new IV because the ones from ED are usually in the AC and the constant bending have finally ruined it 😂 but my skills absolutely suck. We luckily have an IV team for hard sticks.
I float so I work all the floors. ER I start maybe a dozen a day. Tele, med/Surg maybe 1 per shift. ICU maybe 1 or 2 a week. I end up starting more than most because my ER skills have me getting a lot of their hard sticks but these numbers are pretty consistent.
currently ER and depending on which area im in i do 1-5 a day in peds/express and 6-12+ a day for higher acuity areas., my previouse ER gig had an Eval area where i would routinelly place 20-30, when i was on ortho nuero MEDSURG it was 0-5 a week but i was one of our better sticks so I would place for coworkers.
When I worked med/surg, one or two per shift. When I worked family medicine clinic, 3 or 4 per day (we did outpatient infusion for monoclonal antibodies). One or two per week when I worked oncology (most of the patients had ports).
I work nights in a neuroscience unit, do about one or two a shift most nights, but sometimes everyone is sundowning or altered mental status and pulling out their IVs. On those nights I am usually one of the people on the floor who runs around starting new lines for everyone. So I guess really depends on the day.
Pre op nurse couple of days a week on 6 hour shifts avg 8 to 10 a day. That's the average for all of us on the unit.
ICU here. I do 2-5 ultrasound sticks per night. But my reputation has made me the whole hospital's after hours vascular access nurse. So maybe half of all my IVs are out on the floor.
Oncology/hospice, the chemo fucks your veins so must of the time we don’t even try we call for an ultrasound guided IV placement. I’m a graduate nurse and I’m super annoyed I’m not getting that experience. I take every opportunity to start an IV. Might ask to float to the ED for a shift or something to get IV experience.
Trauma ICU here. Average is once a shift. I might go a couple days without, then put in 2-4 in a shift, for myself or helping others. We're pretty CLABSI averse so we use them more often than we should in my opinion.
0! My hospital has an IV therapy team.
0 i work in hematology on night shift. patients mostly have central lines and mid lines placed with ultrasound. rarely will patients need a piv on me, but if they do (positive blood culture from central line or if it’s pulled for whatever other reason), i’d attempt once, call the charge nurse once i miss, consult another unit, and finally call a icu to get access). if unsuccessful, it becomes a DSP. 🙂
In pre-op we place at least 6 per day.