I will never forget this patient. I met her at a large academic medical center at 4:15 in the morning. She was in a small room next to the emergency department where she had spent the entire night with the staff trying to figure out what was going on so she could get the right treatment. She was exhausted and in pain. She told me that between IV attempts and blood draws for lab work, she had been pricked with needles 41 times. Judging by her arms, it was clear she was not exaggerating. And now the phlebotomist I was with was about to prick her for the second time since we arrived.
Unfortunately, this type of situation is all too common. Inserting an IV and drawing blood are two of the most common procedures among hospitalized patients in the United States. Up to 90% of patients require an IV line and, on average, require two blood draws per day. A recent Harris Poll revealed eye-opening data on the problem of repeat needlestick injuries in hospitals. More than half of Americans have experienced multiple needlestick attempts while inserting an IV and 71% have experienced multiple needlestick attempts while drawing blood. In fact, 11% of recently hospitalized patients reported requiring ten or more needlesticks for a blood draw.
The survey found that more than 9 in 10 nurses agree that repeated needlesticks negatively impact the hospital experience for patients. But in addition to being an unsatisfactory experience for patients and clinicians, these procedures can lead to complications, increased costs, and prolonged hospital stays. They can also amplify the growing problem of venous exhaustion, or the loss of suitable veins for therapy due to damage from existing or past vascular access devices or venipunctures.
The challenge is even greater for the two-thirds of adults who have difficulty accessing IVs, because inserting the first IV or drawing blood often requires multiple attempts. For patients who are readmitted at least four times a year – which is the case for nearly a quarter of hospitalized patients – patients with difficulty accessing IVs may receive more than 50 infusions per year.
With this data in mind, I think of the emergency room patient who received 40+ needle sticks in a matter of hours. There is a better way. We can have an incredible impact for both the patient and the clinician by advancing these two practices alone. To protect patients from venous exhaustion and provide a better care experience, we must reflect on our internalized attitudes and practices, advocate for change, and take action toward evidence-based methods to improve access success.
As a paramedic and nursing student, we placed IV lines in veins that were easy for us to use, but not the best for the patient. We often didn’t draw blood when the lines were placed, and the patient would receive another needle stick once they arrived at the hospital. Seeing the prevalence of practices that created a suboptimal patient experience, I began to look for ways to improve a patient’s experience and outcomes. I learned to place IVs away from areas of flexion, such as the wrist and elbow, where the risk of complications and replacement is much higher. Phlebotomists helped me learn how to draw blood properly, so as not to hemolyze the samples, and to know which tubes were needed. This allowed me to avoid re-drawing the patient. Finally, I learned how to use technology like near infrared and ultrasound to improve my chances of a successful first draw. And I developed a passion for finding ways to reduce vascular trauma.
However, to have a widespread impact that truly contributes to improving the quality of care, we need to educate and train clinical staff to properly assess a patient’s vascular health and identify the skills and tools needed to help ensure a successful first attempt. If a patient reports difficulty with IV access, rather than attempting multiple placement attempts ourselves, we can bring in an experienced team with advanced skills and tools who may be able to place the device more quickly and efficiently, reducing the number of needle sticks, reducing wasted time, and reducing delays in care.
To help maintain vascular health, we need to use innovations designed to minimize vascular trauma caused by inserting and replacing IVs and by repeated blood draws. These include:
- Ultrasound-guided needle positioning and tracking systems that can help reduce the number of attempts and time required to successfully access vessels.
- Specialized needle-free blood collection tools designed to utilize an indwelling peripheral intravenous catheter for blood collection to minimize venipunctures and help improve the patient experience.
By adopting and advocating for these new, improved standards of care, we can move away from “the way we’ve always done it” to a more compassionate and effective approach by minimizing multiple attempts to place or replace an IV and limiting repetitive needle sticks for blood draws and re-draws.
It is time to change our practices for the better – for us as clinicians, for our patients, their families and loved ones.
Photo: kuarmungadd, Getty Images
Jon Bell is a Registered Nurse with a Master’s degree and over 25 years of experience in emergency medicine and 15 years of surgical care. He has combined his experiences to specialize in vascular access training and has built a successful team of vascular access specialists. Jon has experience as a clinical consultant working for several companies to support vascular access device training. He has presented at several national and regional conferences on vascular access process improvement and research. Jon is currently the Emergency Department Director at Mount Desert Island Hospital.
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