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technology for use in the emergency room, neonatal ICU and outpatient surgery
department.
The hospital doesn't have a specific stick policy in place, but its nurses are
educated about which patients might prove difficult, including those with BMIs
greater than 30 and patients who've been stuck often for the treatment of chron-
ic diseases. Ms. Aiken says her staff trialed 2 devices before settling on one that
weighs slightly less than 10 ounces and is straightforward to use. It comes with
a stand that holds the device in place, freeing nurses to use both hands when
starting IVs.
Avoid excessive puncturing
Lynn Hadaway, MEd, RN-BC, CRNI, president of Hadaway Associates, an infu-
sion consulting firm based in Milner, Ga., says first-stick success rate at the
front line is generally "abysmally" low.
The failure to start IVs on the initial attempt does more than erode patient sat-
isfaction, says Ms. Hadaway, who's also an active member of the Infusion
Nurses Society. She points to the overall waste of resources in terms of nursing
time and used supplies. "The more attempts you make, the more cost you're
incurring that you can't recoup," she says.
Should you rely on vein-imaging technology for every IV start? "Not at all,"
says Ms. Hadaway. "When visible veins are plentiful, the devices aren't needed.
On the other hand, if you place a tourniquet and assess the arm, and if you're
not confident that you can palpate a significant number of potential sites, then
use one of these devices immediately to avoid excessive puncturing of the
patient." Her staff will pull out a device if patients say they were difficult sticks
during previous care.
Multiple failed puncture attempts can also damage and destroy peripheral
veins, limiting their use for subsequent therapies, says Ms. Hadaway, who identi-
fies patients with fluid-volume deficit, chronic diseases such as cancer or dia-
