preop holding area IV insertion

preop holding area IV insertion

posted by Ferdinand Bautista on Mar 12, 2018 2:37 pm

Hello all,

I have a question.  

Who's facility here has IV's inserted by the preop nurses?

Is there an efficiency benefit to it that you notice? and please state the size of your OR so I can better gauge the type of setting.

Reason for the question, there is a big push at my facility by anesthesia for preop nurses to start the IV's.  This is a skill set my preop nurses do not currently have, and the rationale behind having them start the lines seems mute.

I have worked in both facilities that do have preop nurses start the IVs and facilities that have the IVs started in the OR by anesthesia. 

Looking for insight from the general masses on this.

Thank you in advance.

Re: preop holding area IV insertion

posted by Natalie Sorensen on Mar 12, 2018 9:58 pm

Hi Ferdinand,

Our preop nurses and also care partners insert IV's in the preop area on adults. Anesthesia inserts pediatric IV's.  We are a large, academic hospital with 34 ORs.  

Natalie Sorensen

Re: preop holding area IV insertion

posted by Juliana Mower on Mar 13, 2018 10:54 am

I have seen it done both ways: In an 11-rrom OR, the anesthesiologists started their own IVs. In a a 7-room OR pre-op nurses started the IVs exept for very young peds and patients identified as very hard starts (and this was rare; our pre-op nurses were excellent). One anesthesiologist preferred to start her own IVs in the room and this preference was  honored.. Ths is a skill that is easily lmaintained with frequent usage and adequate initial traiing.  It does save OR time if the IV is inserted prior to transfer, and makes administering prophylactice antiobitoitcs more likley to be on time.
Julie Mower

Re: preop holding area IV insertion

posted by Suzanne Moore on Mar 13, 2018 12:52 pm

I am an RNFA in two hospitals that each have six ORs. All IVs are started by the preop nurses. If there is a difficult stick, anesthesia will start the IV. On occasion, I can also step in to start one. This works well for us and seems to expedite the flow of getting the patient ready for their surgery. 

Re: preop holding area IV insertion

posted by Chris Baeten on Mar 13, 2018 3:24 pm

Similar here.  We have preop start IV's in preop, unless peds.  We use 18g for anyone who may have blood loss/blood transfusions, other cases 20 g.  Anesthesia only starts if the preop cannot get one.

Re: preop holding area IV insertion

posted by Ferdinand Bautista on Mar 14, 2018 8:35 am

Thank you all for the insight.  It does make sense, since the facility I know of that does not have RN's start the IV's is a teaching facility with numerous anesthesia residents, who typically start the IV's for teaching/learning purposes.

Thank you again for all your insight.

Re: preop holding area IV insertion

posted by Megan Dudley on Mar 14, 2018 8:42 am

I am a preop nurse at an outpatient surgery center. We have six rooms and average 20-28 cases a day. We start all of our IVs preop with the exception of children 12 and under. This makes the flow of getting the patient to the room smoother. Also it allows for the pt to receive preop fluids and medications prior to going to the OR. 

The only time anesthesia is involved with the IV is if the pt is an extremely difficult stick that no preop nurse can get. 

I was was very surprised when I read your post that your nurses do not consider this in their “skill set”. It’s a good skill for all nurses to maintain. 

Re: preop holding area IV insertion

posted by Christy Elliott on Mar 14, 2018 9:39 am

We are a multi-speciality ASC with 3 ORs and 2 Endo rooms with an average daily case load of 40.  All IVs are inserted by the pre-op nursing staff (RN/LPN) with assistance from anesthesia (all CRNA staff) as needed including pediatric patients.  Peds under our age and weight limits or overly anxious children are started in the OR by the RN circulator or CRNA.

All Phaco cases get a saline lock with a #22 gauge, all general and endo cases receive a #20 gauge with ordered fluids.

The IV in the preop area allows us to treat issues prior to the start of the case such as the need for dextrose, insulin, anti-hypertensive meds, antianxiety meds and to start our IV ABX timely.  It would greatly slow us down to have the CRNA staff start all of the IV's expecially on Tuesdays when we average 55-75 cases.

Re: preop holding area IV insertion

posted by Donna Jean Ottinger on Mar 14, 2018 11:14 am

Our preop RN's start IV's for many reasons.  Often antibiotics are requested to be started in preop, as well as, helps with ontime starts.  Anesthesia will assist when requested in situations that an IV is difficult or US guidance is requested.  We are in the process of having RN's educated on using the US to assist with difficult IV insertions.  I have worked in both the community level hospitals and Level One Trauma Centers and preop has always placed the IV.s 

Re: preop holding area IV insertion

posted by Alvin Aguirre on Mar 14, 2018 3:24 pm

Great posts on this topic. Does anybody have a written protocol or flow diagram they can share?

Re: preop holding area IV insertion

posted by Hung-Fu Lin on Mar 14, 2018 5:26 pm

Our PreOp team starts all IV's with a "2 stick attempt total" rule by different nurses before calling anesthesia to start the line (facility policy). Anesthesia very rarely starts them in the OR, but it does speed up efficiency by allowing them to pre-medicate. All IV's are attempted with 0.1mL 1% lidocaine also. I am the only OR RN who starts IV's in any of my facilities since I came from a Trauma/ER background, so I also float to help PreOp when OR has a lower census. For our pediatric patients, either I or another nurse that I trained starts them for anesthesia, so they can focus solely on the airway as part of the ENT team. This is a basic nursing skill that is lost to the majority of OR nurses. For more difficult starts, you could consider the use of the Wee light for pedi patients or "Vein Finder." Another consideration is for some nurses to consider getting training to perform Ultrasound-guided IV's (great skill to have!).

Re: preop holding area IV insertion

posted by Diem-Chi Phung on Mar 15, 2018 12:13 am

I have worked in 3 different facilities and all 3 have the Pre-Op RN start the IV’s. My current facility has 13 OR’s and the SDS dept at 4 OR’s. Policy states that RN has 2 attempts and then must call Anesthesia for assist. Pediatric and special need pts are masked in the OR and then the RN starts the IV. Proper IV starts is a skill only gained from practice and repetition, but it’s also a basic skill learned in nursing school. 

Re: preop holding area IV insertion

posted by Ellen Bencken on Mar 15, 2018 5:27 pm

Every facility I've worked in for 3 decades has IV starts done in Preop.  All of our regional anesthetics are done in Preop as well.

The patient is ready for induction when they are settled on the OR table or in case of a regional, they are ready to prep.
Ellen Bencken RN BSN CNOR eChapter Past-President

Re: preop holding area IV insertion

posted by Afton Quesenberry on Mar 16, 2018 8:24 am

My community hospital has a 3-room OR with roughly 20 employees in the Surgical Services department. In most cases, IVs are obtained by the pre-op nurse at the time of admission. These nurses are skilled in IV starts and maintenance. Mornings can be very busy for the department, so for this reason the first 1-2 patients may arrive to holding without an IV, so the pre-op nurses can be available for admissions. I would estimate that half of the OR nurses are skilled/comfortable with starting lines and accessing ports. If a patient appears to be a "hard stick," nursing will refer to anesthesia for the line access. This is just what works for our small facility.
That being said, I personally agree that line starts and maintenance are a crucial skill for every RN to stay practiced in. For example, I was once circulating a bronchoscopy and the patient coded suddenly due to bronchospasm. My CRNA needed to focus on the airway and asked me to obtain a second IV stat. Luckily I felt comfortable doing this in a high-pressure situation and was able to obtain  access quickly. For that reason, I strongly believe that fundamental nursing skills should be maintained by all RNs in the peri-op setting.

Re: preop holding area IV insertion

posted by Ferdinand Bautista on Mar 16, 2018 4:24 pm

Thank you again for all your input.

Just to play a little "devil's advocate" for those of you in teaching instituitions with anesthesia residents, how would residents gain the IV skill if the preop nurses are mainly inserting them?  We all know it is a skill that comes with time and repeatition but if we limit their attempts how is it they can then be the backup to us if they have less skills/exposure?  This is question is obviously just for PIV and not any type of central line.

Again, just playing devil's advocate.

Re: preop holding area IV insertion

posted by Robert Blumm on Mar 17, 2018 7:27 am

Hi Ferdinand:
I operate in an OR that has 6 rooms and Endoscopy and all of the IV's are started by the pre-op nurses. Looking at the responses it would behoove you to have your nurses trained to start IV's perhaps with the suggestion that after two attempts they should be started by the anesthesiologist. Remember, we want to get our antibiotics in the patient one hour prior to incision and the first case in the morning will be late for this as many anesthesiology groups do not have their members come to th hospital until twenty minutes before the first case. Some of us remember the IV teams on the floors which were ideal as they all became expert but was discontinued for reasons of paying 2-4 nurses to function in this role. they were excellent and were there for all the needs of IV and oncology care and would be a wonderful gift to nursing if they were returned.

Re: preop holding area IV insertion

posted by Leigh Bartlett on Mar 17, 2018 7:57 am

We are a 3 OR rural community hosptial and our preop nurses start the IVs except the pediatric patients get theirs in the OR.

Re: preop holding area IV insertion

posted by Susan Draper on Mar 17, 2018 9:58 am

We are a large academic hospital with 31 ORs and a seperate PEDS OR. Our IVs are started by nursing in the admission area by nurses, from there they are either a direct to the OR or to Pre An then the OR. The nurses use 0.1 cc lidocaine SQ and then will insert the IV. They give the patient the option of the lidocaine. On difficult sticks, anyone that is certified can try. We also use a vein locator if needed. It saves time and if everything is ready and signed, marked etc. Anesthesia will give them some relaxing medication while waiting or just before transport to the OR. On children if they are old enough and can tolerate it and IV is inserted by an RN, if not they are put in after mask induction while the patient is still breathing on their own.

Re: preop holding area IV insertion

posted by Mojeed Motunrayo on Mar 17, 2018 7:07 pm

I'm a registered nurse in Nigeria, at the moment I'm working in a private hospital... I received my qualifications two years ago when I had no knowledge of setting an iv line ... And this was a great challenge when I started working ... It makes me feel inferior and I have to wait for my other colleagues before I could work. But during this period I had no choice than to learn so I won't look incompetent ... N till date ... I'm a pro at setting line ... I actually think all nurses no matter the unit or specialty should know how to access IV line.. We never know when the situation for it might arise

Re: preop holding area IV insertion

posted by Melanie Burton on Mar 18, 2018 10:42 am

When this practice was started in my in hospital ambulatory surgery of 10 rooms, it saved the time in the operating room and it allowed the pre operative medications to be given to comply with the anesthesia protocol.  It was a very fast turnover environment.
​Melanie Burton, Seattle

Re: preop holding area IV insertion

posted by sheree watson on Mar 18, 2018 5:13 pm


IVs are inserted in the pre-op area at my hospital. For us, this saves time in the operating room and also allows for patients to recieve anxiolytics before coming to the operating room.
My facility is a teaching hospital with 34 ORs.

Re: preop holding area IV insertion

posted by Suzanne Brown on Mar 19, 2018 9:43 am

I agree with you on that!  I was told in nursing school I would learn how to start IVs when I started working, and my first job as a new grad was at a teaching institution.  When the hospital educators saw I was hired to work in the O.R., I was told I wouldn't need to learn to start IVs because the anesthesia residents would be doing that.  So I was never taught that skill.   

Re: preop holding area IV insertion

posted by Mary Von Ohlen on Mar 19, 2018 10:33 am

Our Pre-Op department start the IV's on the adult patients in the holding room. Babies and small children are started in the OR after anesthesia bags them down, the circulator starts the IV. Most IV's started in Pre-Op are for pre-op meds, ordered after anesthesia interviews the patient. 
Mary H. von Ohlen BSN, RN, LMT, CNOR

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