The Role of the IV Nurse
The Role of the IV Nurse
The presence of an IV therapy team elevates the standard of infusion care in a facility by reducing infection risks and improving patient comfort
Parenteral fluid administration has been an essential component of the care of hospitalized patients since 1940, when Massachusetts General Hospital designated one nurse to be its first intravenous (IV) nurse specialist. As developments in parenteral therapy have progressed, the role of the IV nurse has similarly expanded. By the 1970s, IV nurses were performing functions that previously were done by medical staff alone, such as neonatal care, anti-neoplastic therapy and intra-arterial therapy. The National Intravenous Therapy Association Inc., later to become the Intravenous Nurses Society (INS), was established in 1973 to support and educate professional IV nurses in this growing clinical practice area.
Today, more than 90 percent of hospitalized patients receive some form of IV therapy. When they leave the hospital they may not remember such things as the room they were in or the name of the test performed. Most, however, recall their needlesticks. A proficient IV nurse minimizes the anxiety and pain associated with this experience.
Many hospitals have IV therapy teams composed of specialized nurses who maintain their infusion therapy. IV therapy team functions include placement of vascular access devices (VADs), maintenance of VADs, administration of parenteral fluids and support of nursing service personnel. These functions vary from hospital to hospital and state to state, depending on state nurse practice acts, but all share common practice components.
The primary function of the IV therapy team is the placement of VADs. Appropriate VADs are placed after assessing patients’ needs and often conferring with the patient’s primary RN, physician and sometimes nutrition support personnel. Although peripheral VADs are most frequently used, many IV nurses are proficient in the placement of peripherally inserted central catheters (PICCs).
Another function of IV therapy teams is the care and maintenance of VADs. Peripheral IV sites are assessed and evaluated, with dressing care, tubing changes and site rotation provided as needed. Routine peripheral IV site rotation is an important function of an IV therapy team, with documented evidence suggesting that peripheral VADs left in place for longer than 72 hours are a significant infection risk. IV therapy teams provide central line care as well, maintaining dressings and tubings, obtaining blood samples and assessing line integrity. Central line care often involves other highly specialized tasks such as declotting and repairing central catheters and accessing and deaccessing implantable ports.
Administration of parenteral fluids is another IV therapy team function. IV nurses often exclusively handle the administration of blood products and antineoplastic agents due to the many associated potential risks. IV nurses work closely with pharmacy services, the medical staff and patient care nurses, often conferring on drug compatibilities, reactions and outcomes.
IV therapy teams function as an educational resource and support to hospital personnel, particularly nursing services. IV nurses are able to perform time-consuming IV-related skills efficiently, freeing nursing staff for other duties. IV teams are valuable in providing ongoing teaching to other hospital personnel on aseptic technique, IV insertion and other aspects of IV therapy.
Study Confirms Value
A study conducted at Michael Reese Hospital and Medical Center in Chicago and reported in Archives of Internal Medicine in March 1998 concluded that the presence of a dedicated IV therapy service team significantly lessens the incidence of IV-related complications. The study noted that uniform catheter insertion technique and routine IV site monitoring contribute to the reduced rate. However, the greatest single factor contributing to lower complication rates is the timely removal of IV catheters.
Patients cared for in the study by the IV team not surprisingly used a greater mean number of catheters. Many hospital protocols require routine IV site rotation every 72 hours, but such guidelines are not always followed consistently by hospital personnel. Non-compliance is often attributed to multiple demands on busy nurses. Strict adherence to aseptic technique and site rotation guidelines is the primary focus of IV therapy teams.
The Association for Professionals in Infection Control and Epidemiology (APIC) supports the presence of IV therapy teams as the best way to reduce catheter-related infections. These recommendations were outlined last year in the APIC Text of Infection Control and Epidemiology.
Although challenging to measure and document, the presence of an IV therapy team increases patient satisfaction by providing the highest level of quality in infusion therapy. If “practice makes perfect,” then they are the experts. IV nurses are able to enhance patient comfort with their proficiency and are more successful with difficult IV catheter insertion. They are frequently called upon to perform venipuncture when others are unsuccessful. In the study above, the IV nurses were successful with venipuncture on the first attempt 81 percent of the time.
One Hospital’s Experience
Our facility, Northside Hospital in Atlanta, has had an IV therapy team since its doors opened in 1970. Northside Hospital is a 455-bed, not for profit, full-service hospital with more than 1,470 physicians on staff. Renowned for its expertise in surgery, Northside specialists perform more than 25,000 surgeries annually, among the highest number in the state. One of the Southeast’s premier hospitals for women’s services, the facility ranks first in the nation among community hospitals in the number of babies delivered, with more than 15,000 in 2000. The Women’s Services program, including Women First and the Northside Hospital Women’s Center, is dedicated to caring for a woman’s health throughout her life. In addition to advanced obstetrical and gynecological care, Northside Hospital features a neonatal intensive care unit. It also has a nationally recognized oncology center, including a very active bone marrow transplant service. The latest in breast cancer treatment and community education programs on a wide range of topics also are available.
The IV team at Northside consists of 25 registered nurses, including full-time, part-time and per diem employees. We provide a 24/7 hospital-wide service. Five nurses are on duty from 7 a.m.-7 p.m. and three from 7 p.m.-7 a.m. The team is responsible for covering all med/surg adult patient care areas, making daily visits to these patients and additional visits as necessary. We attend all code blues.
IV nurses are the only nurses at Northside Hospital certified to insert PICC lines. In 2000, the IV team placed 445 PICC lines, including both inpatients and outpatients. Additionally, our IV team supports our specialty units such as the emergency department, labor and delivery and critical care units, providing them with IV services when necessary and on a consultative basis.
The Northside Hospital IV therapy team employs five nationally certified nurses, with several more preparing for the examination this year. Five of our nurses have been nominated for the hospital’s annual clinical excellence award and three have received the award. Two members of our team serve as current board members of the Southeastern Chapter of the Intravenous Nurses Society, one as president and one as treasurer.
While IV therapy teams have proven their value time and again, their future may not be set in stone. Hospitals are seeking ways to reduce costs and deal with managed care. Many have made cutbacks by eliminating their IV therapy teams.
The presence of an IV therapy team elevates the standard of infusion care in a facility by reducing infection risks and improving patient comfort, providing an excellent customer service. We take great pride in the Northside Hospital administration for recognizing the added value of an IV therapy team.
Association for Professionals in Infection Control and Epidemiology. (2000). APIC text of infection control and epidemiology. Washington, DC: Author.
Maki, D.G. (1994). Infections caused by intravascular devices used for infusion therapy: Pathogenesis, prevention and management. In A.L. Bisno, F.A. Waldvogel (Eds.), Infections associated with indwelling medical devices (2nd ed.) (pp. 155-212). Washington, DC: American Society of Microbiology.
Soifer, N.E., Borzak, S., Edlin, B.R., & Weinstein, R.A. (1998). Prevention of peripheral venous catheter complications with an intravenous therapy team: A randomized controlled trial. Arch Intern Med, 158(5), 473-477.
Weinstein, S. (1993). Plumer’s principles and practice of intravenous therapy (5th ed.). Philadelphia: J.B. Lippincott.
Barbara March is certified in intravenous therapy and has been supervisor of IV therapy at Northside Hospital, Atlanta, for the past 13 years. Ellen Marrs has been a staff IV nurse at Northside Hospital for the past 11 years.