Intravenous therapy in hospitals is common practice. Nurses today participate in many high risk activities; including IV insertion and maintenance. IV therapy has many pitfalls for the nurse and a patient as IV therapy puts the patient at risk for infection, phlebitis and tissue extravasation, and the nurse at risk for a law suit.
I start many IV’s every shift. Sometimes, I start them on my own patients; sometimes I start them on other nurses’ patients. Unfortunately, many of my colleagues do not have the skills or experience I have starting IV’s. Many nurses stick a patient several times failing to achieve a patent IV site. The nurse feels defeated, and the patient is left bleeding and bruised. The nurse begs me to miraculously find a vein as she runs off to catch up with other duties. Often, some nurses can get so busy and behind with their other patients, preventing them from neither accurately remembering, nor documening IV attempts. So nothing is charted about failed attempts by this nurse.
Unfortunately, my name is one of the few listed on the chart with regards to IV’s.
What is my liability? Might I be held accountable if the patient develops a complication from a failed attempt by another nurse? With all the bruising and bleeding visible on the patient’s arm, how am I to know where the previous IV site was? One of the biggest problems is when a new site is placed below a previous site. This is a clear violation of the INS standards of practice.
When medical cases are taken to court, without clear documentation of the exact IV site, expert reviewers are able to determine the exact sequence of the sites and which nurse(s) were responsible for making the poor decision about site selection. One nurse may not have any liability but the documentation is the only thing that can help to clear or eliminate those nurses from a lawsuit.
If you find yourself in this situation, precise documentation is key. And when I say precise, I mean precise. Quickly documenting 20 g. cathalon “right forearm” is not sufficient. "Right arm" or "left hand" is definitely NOT sufficient. If a nurse charted the use of the right cephalic vein, this provides no useful information because the cephalic vein extends from slightly above the thumb through the entire upper extremity and up to the shoulder.
Sloppy documentation puts the nurses and hospital at a legal risk because the reviewer, many years later, can not tell what actually happened. This usually results in all nurses being named in a given lawsuit. The INS standards of practice states that documentation includes "identification of the insertion site by anatomical descriptors, landmarks, or appropriately marked drawings." Proper documentation would include "the right cephalic vein about 5 centimeters above the wrist,” as well as accurate, date, time, site condition and dressing application, and medication infusing.
Even the best lawyer must be frustrated when reviewing a set of medical records in a pending lawsuit. Proper documentation of IV sites is dangerously lacking in many cases. If a lawyer can not determine the exact location of an IV site, then how would they know who started that site? If a nurse is unable to remember who, what, where, and when from shift to shift, how can we expect a nurse to remember years later?
Remember, even though you are rushed and incredibly busy, proper documentation is your best protection!