My best friend's hospital stay

[Akasa]

My best friend was in the hospital again with kidney stones, and the nurse when she went to put in the IV really screwed it up to the point that my best friend was "GET IT OUT GET IT OUT GET IT OUT GET IT OUT GET IT OUT" *reach over yank it out*
Nurse: "Oh did it hurt?"
My best friend cursed up a storm and didn't let her try again.
6 days later her hand is swollen and bruised, like she blew a vein, but when she blows a vein it goes down in a day.

Later on she called the nurses station for something and the nurse didn't hang the phone up all the way and made a comment that it was the bitch(in Spanish) in room 325, then when her husband went to the nurses station and raised hell she had the nerve to lie and say she didn't say it. He was like she can be a bitch, but hang up the phone before you call her one that was really unprofessional.

The charge nurse came in and was shocked to hear it and was like yeah we do have a nurse that uses that phrase. That first nurse didn't come around any more.

[firecat88]

*huge hugs to your friend* Good night. So many unacceptable things going on in this story.

First of all, you do *not* just rip out an IV. Even if it's been put in wrong the first time (which I'm convinced you should always get an anesthesiologist to do IVs anyway. They're better at it than a lot of nurses), you remove the damn thing carefully and slowly. Because, yes, improper placement and removal of those things will leave a baseball-sized bruise. I know this first-hand.


Second, you do *not* badmouth patients behind their backs while you're on the clock. If you want to vent about a patient you disliked, do it at home on your own time. Not at the freakin' desk where someone is definitely going to end up overhearing and it'll come back to bite you in the ass.

Thirdly....calling someone a bitch like it's her fault, rather than owning up to the fact that you're the one who messed up the IV and caused her to be in so much pain? So not right.

[Gawdzillers]

*huge hugs to your friend* Good night. So many unacceptable things going on in this story.

First of all, you do *not* just rip out an IV. Even if it's been put in wrong the first time (which I'm convinced you should always get an anesthesiologist to do IVs anyway. They're better at it than a lot of nurses), you remove the damn thing carefully and slowly. Because, yes, improper placement and removal of those things will leave a baseball-sized bruise. I know this first-hand.

I think her friend's the one that ripped it out, not the nurse.

[Thatgirl71]

I'm sorry your friend had such a bad experience while in the hospital. Sounds to me like that nurse is burning out and needs to take a break.
I know how it feels to be given a bad time by a nurse, I had a very bad experience with one that to this day I can't even talk about or barely think about or I get the shakes. Luckily, like your friend, I had family members that took care of it, but I hope to never have to go through that again.

[Sapphire Silk]

(which I'm convinced you should always get an anesthesiologist to do IVs anyway. They're better at it than a lot of nurses)

I respectfully disagree on this part. First of all, it does not make financial sense for a hospital to have an anesthesiologist do a task a trained nurse is perfectly capable of doing. Starting IVs is really not that hard to perfect as a skill . . . it simply takes practice.

Even the best will sometimes miss a vein.

Many nurses are as skilled or more skilled than an anesthesiologist. Nurses who work in the OR, ICU, ER, IV therapy teams, or outpatient surgeries put in IVs all day long.

Nurses on med surg units. . . . maybe not so much. Long term care? Hardly ever.

That being said, the patient in the OP had a horrible experience. The nurse couldn't admit she did a bad job on the IV and apologize, then took it out on the patient at the nurses station. Totally unprofessional . . . and it makes me angry.

I've been the victim of a bad IV job. When I was in the hospital with the flu, badly dehydrated, my IV infiltrated (leaked into the soft tissues of the hand). The nurse who tried to restart stuck the needle into a tendon . . . then said, "hold still, I've almost got it," when I started crying in pain. "It's in the tendon, the tendon!" I wouldn't let her have a second stick, and told her to call the ER.

They sent a paramedic to restart it. He stuck me once, and I didn't even feel it. Whew!

[Teskeria]

The only person to successfully get an iv in me in less than 3 attempts (average is 5-10) was an neonatal nurse. Of course considering the size of the veins she usually worked with, my tiny disappearing ones were nothing....

[Seshat]

I would far prefer an experienced nurse or phlebotomist than almost anyone else.

And yes, by 'experienced nurse' I mean one who starts IVs or draws blood multiple times a day, most working days.

[AccountingDrone]

The only person to successfully get an iv in me in less than 3 attempts (average is 5-10) was an neonatal nurse. Of course considering the size of the veins she usually worked with, my tiny disappearing ones were nothing....

The phlebotomist at Yale New Haven I normally go to for testing sidelines at a vet clinic. He says if you can set an IV in a cat, you can set one anywhere.

[DeltaSierra]

*huge hugs to your friend* Good night. So many unacceptable things going on in this story.

First of all, you do *not* just rip out an IV. Even if it's been put in wrong the first time (which I'm convinced you should always get an anesthesiologist to do IVs anyway. They're better at it than a lot of nurses), you remove the damn thing carefully and slowly. Because, yes, improper placement and removal of those things will leave a baseball-sized bruise. I know this first-hand.

Try a mind-boggling THIRTEEN (yes you read that correctly) attempts to get an IV in me the last time I was hospitalized (severe reaction to an antibiotic + dehydration) - they eventually called - you guessed it - the anesthesiologist! He got it on his first try (I'd gone thru 2 phlebotomists, 1 nurse and a resident all attempting before the anesthesiologist was called.) This scares me... I go for a 2-week phlebotomy practical at my local hospital starting May 16!!!

[Akasa]

For the record it was my best friend that took the IV out. Not the nurse.

[Primer]

My problem is these new-fangled IV sets that "push" the catheter in rather than the nurse setting it in. I have tough, getting-leathery skin on my hands. the catheter gets caught somewhere on the way in and bends. It also hurts like a I have a perfectly good, easy to use vein inside the left elbow. I understand that medics don't like to use that one, but for a short duration, where I won't be bending my arm, why not?

[Sapphire Silk]

My problem is these new-fangled IV sets that "push" the catheter in rather than the nurse setting it in. I have tough, getting-leathery skin on my hands. the catheter gets caught somewhere on the way in and bends. It also hurts like a I have a perfectly good, easy to use vein inside the left elbow. I understand that medics don't like to use that one, but for a short duration, where I won't be bending my arm, why not?

The point of those kits is to actually help the nurse slide the catheter in, while also trapping the needle so the nurse can't accidentally stick herself later. They take a little practice to learn to use. There also are a variety of styles, each work a little differently but hospitals tend to buy the ones from the company that offers the best deal rather than the best technology.

The secret to a successful IV insertion is to push the needle a fraction more into the vein after you get blood return ("flash") because the tip of the needle extends slightly past the end of the catheter. The risk is you might push too far and go completely through the vein. That's the tricky part of IV insertion. But if you do it right the catheter simply slides into the vein.

Sometimes you run into a valve that prevents the catheter from advancing. If you've pulled the needle back too soon, the cath will bend and is harder to advance. Sometimes you can "float" a catheter past a valve like this by connecting the catheter to a syringe filled with saline, or to the IV line which you then open. The pressure from the fluid will force the valve open, and you can slide the catheter through it. It doesn't always work though

I don't like to use the crook of the elbow, either ( the antecubital or AC space). In many patients even the slightest flexion or extension of the elbow will bend the IV cath and stop the IV from flowing, and many patients can't tolerate holding their arm still for even a few hours. I'll use it in an emergency, but may restart a new one somewhere else later if the patient is going to be in the hospital for any length of time.

We also like to start low and work our way up the arm. If a vein blows, you can't restart below that site; you'll just cause swelling and edema. You have to go above. So if you start too high and blow a vein, you could lose access to the entire arm until the vein heals.

I try to avoid starting them over joints (fingers, the wrist, and the AC) because any flexion or extension of the joint could cause the site to become "positional" . . . it will flow only if the joint is in just the right position.

[Seshat]

Panacea,

It's really interesting to hear these reasons for things. Thank you for being willing to explain them.

[jnd4rusty]

I have only had an IV once in my life and they had a hell of a time trying to get it in, they could not "find" my veins so they finally gave me something that, I guess they give to heart attack victims, is supposed to enlarge your veins or something like that. All I know is after they gave me that then it only took one shot at finding a vein. (I detest needles!!!!)

[Sapphire Silk]

Panacea,

It's really interesting to hear these reasons for things. Thank you for being willing to explain them.

My pleasure I figure I'm doing both patient and nurse a favor by helping people understand the whys and wherefores of what we nurses do. If it helps make an encounter with a health care provider satisfactory, or empowers a patient to speak up when they're not, then I figure I'm doing my most important job as a nurse: patient advocate

I have only had an IV once in my life and they had a hell of a time trying to get it in, they could not "find" my veins so they finally gave me something that, I guess they give to heart attack victims, is supposed to enlarge your veins or something like that. All I know is after they gave me that then it only took one shot at finding a vein. (I detest needles!!!!)

Hmm. I'm not sure what that could be . . . I don't know of anything other than heat that is used to enlarge veins.

Sometimes we'll use something call EMLA cream, which is a numbing cream, to reduce pain. It doesn't always work, and has to sit there for 15-20 minutes even when it does work, so I don't like to use it in the ER much. Or sometimes I'll inject a little 1% lidocaine into the soft tissue around a vein to numb the area . . . but that hurts too, so I don't always see the point in bothering.