Intravenous nurses make points

Being an intravenous nurse involves a lot more than sticking patients with needles.

This specialty branch of nursing, with teams in most major hospitals, requires specialized training to install complex central catheters and to operate new technology making them safer to implant and less apt to cause infections.

There are 13 nurses on South Shore hospital's IV team, who work 24/7 offering support to 36 departments in the hospital.

Clinical coordinator and team leader Irma Sivieri has 10 years experience as a nurse, eight of them as an IV nurse.

"The IV team is a support team for other nurses in all aspects of vascular access," Sivieri said. "We're like the 'A' team. Nurses call us and we have to come in and help them immediately."

Many hospital patients probably remember a nurse calling in a member of an IV team to put in an intravenous fluid line, finding the right vein in the arm and inserting it on the first try. The regular nurse may not be able to find a vein because a patient is elderly, obese or has had a lot of other infusions.

But often their work is a lot more complicated. They are called in to assess patients who need IVs for long-term antibiotic treatment or for drugs that inflame veins. They put in peripherally inserted central catheters also known as PICC lines, a complicated procedure that involves running a catheter from the arm up and over to the superior vena cava, a vein just above the heart.

"I had a 95-year-old patient who was bleeding and her blood pressure was very low and they couldn't get an IV in her," Sivieri said. "We managed to get a central line in to stabilize her."

The South Shore IV team puts in about 600 PICC lines a year.

To help with the process, IV nurses learn to operate high-tech equipment such as the Site Rite Vision catheter system, which uses ultrasound to locate veins in the arm and to help thread the PICC line 40-50 centimeters from the arm vein to the superior vena cava.

To put in PICC lines, nurses must have the CRNI — Certified Registered Nurse Infusion — credential, which requires 1,600 hours of nurse IV experience and passing a written national exam.

"To be a good IV nurse, you have to have the skills and be passionate about doing it, said Laurie Hayes, a member of South Shore's IV team with 15 years of experience. "People often mistake IV nurses for phlebotomists."

Debra Ayers was a med/surg and ER nurse for seven years before joining South Shore's IV team two years ago.

"You have to command respect and be able to build rapport with patients in less than 10 minutes," said Ayers, who also teaches in the nursing program at Quincy College. "IV nursing is not generally taught in nursing school. You have to learn it on the job. And you have to have your anatomy down cold to know where every vein is."

Randall Barnes, a former IV nurse and president of the New England Chapter of the Infusion Nurses Society, says that IV teams have become critical to many hospitals because those who have them have lower rates of infections from IVs and infusions. Patient satisfaction is also better, which rewards the hospitals with higher Medicare payments.

The Bay State INS chapter is the largest in the United States with 189 members, 60 percent of whom are hospital IV nurses and 40 percent who do home care.

The South Shore Visiting Nurse Association has its own IV team, which serves patients at home in some 39 surrounding communities, said Mary Walsh, who founded the South Shore team and has been an IV nurse since 1984. She said IV nurses help discharged patients continue antibiotic treatments and even some chemotherapy at home.

"You're often working with a whole family, teaching them how to flush lines and keep everything antiseptic," said Walsh, who is now the chief nursing officer at Hebrew Senior Life's NewBridge on the Charles retirement community, where she oversees IV resources in its 48-bed rehabilitation center.

With new technology coming, Walsh adds that IV nurses will be able to place even more complicated catheters such as internal jugular lines.

After years as an IV nurse, Barnes now has a job at Bard Access Systems, developer of the Site Rite 
ultrasound catheter system, educating IV nurses on the new technology.

Barnes said the perception of the specialty has changed. IV nursing used to be more synonymous with infusion nursing, but Barnes said the new skills and technology are being used more for IVs than for chemotherapy infusion.

"It used to be that IV nurses were those nearing retirement who want to ease off a bit," he added. "But today it's a very busy job."

Sivieri said there are multiple calls for IV help at any one time, and that team members must be able to prioritize which ones are the most important.

"To be a good IV nurse, you need to be able to work independently and to work on a teamss," Sivieri said. "And you have to be a 
decision maker. You may be alone on an overnight shift and it's your call."

Patient safety is a big concern in placing advanced catheters, and South Shore's protocol is to have two nurses to install PICC lines.

"You must be 100 percent focused on the job," said Ayers. "It's challenging work for a nurse, but I like the variety of the job. Every day is different."

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