4/14/2016
The number of venipuncture attempts to insert a short peripheral catheter is a critical factor in the ultimate health of your patient’s veins. The 2016 Infusion Therapy Standards of Practice call for no more than 2 attempts per clinician with a limit on the total number of attempts to 4. After 4 unsuccessful attempts, it is time for a careful assessment of VAD needs and discussion with the patient’s providers to decide on the most appropriate options. Many experts would argue that 4 attempts are too many! Think about those 4 veins that have been punctured, damaged and will now have a small amount of scar tissue.
We have all encountered those patients with difficult venous access – no peripheral veins can be seen or palpated. Or the veins that can be felt are hard and rope-like meaning they are sclerosed. I have often wondered how many failed venipuncture attempts these patients have endured.
Many healthcare issues cause damage to the vein wall – some within the patient’s control such as smoking and some due to chronic illnesses such as diabetes. The number of patients with chronic diseases requiring frequent venipuncture is growing. Blood sampling, receiving diagnostic tests such as CT scans with I.V. contrast, or courses of antibiotics for frequent infections translates to numerous venipunctures. But failed venipuncture attempts are directly related to the skill and judgment of the clinician. Vein damage occurs regardless of whether the attempt was successful or not.
The goal is vein preservation so that peripheral veins remain available for the entire lifetime. Many times, a central venous access device is needed for no other reason than an absence of peripheral veins. A CVAD carries the greatest risk of bloodstream infection and vein thrombosis, so the goal is to use them ONLY when the length, frequency, and characteristics of the infusion therapy demand the tip location in the superior vena cava. By protecting patient’s peripheral veins, these goals are possible.
Never make a venipuncture attempt blindly, without being able to see or feel a vein in good condition. Assess both extremities for the total number of sites available. If there are very few sites, and you do not think your venipuncture skill is sufficient for the level of difficulty, call the infusion/VA nurse or another clinician with more experience and inform them that near-infrared light or ultrasound may be needed. Consider the length of therapy and the characteristics of the prescribed medications. Don’t stick a vein in a finger or some other odd location just for the sake of saying you can do it. And finally work to change those terrible policies requiring that the patient’s nurse make a certain number of attempts before they call for assistance. These policies add to the problem of vein wasting and ignores the goal of peripheral vein preservation.
