Combative: IV Insertion

All right guys. In this lesson, we’re going to talk about putting in an IV in combative patients. Now, combative patients from the very beginning are always something that drove me a little bit, um, and to some anxiety about having to deal with them and then I get an order for Nivea. So let’s think about this. What are we, what should we do when we, when we’re doing IVs and combative patients, number one, the first thing we want to do is think about patient and nurse safety. You should never assume that you can talk a combative patient into compliance. You want to try to put them in a position where they feel comfortable and that they’ll be cooperative, but you also have to understand that that you will need to get help. There is, it’s nearly impossible to try to put in an IV in a patient that’s going to be maybe swinging at you.

Even if they have restraints you, you potentially could harm the patient or you put yourself at a disadvantage of maybe an accidental needle stick. This is where people get hurt. This is where patients are, are potentially injured. So always get help if you need two or three nurses. That’s totally okay. What you also want to do, well, you want to think about when you’re putting in IVs in, um, in combative patients is if your patient is potentially going to have a restraint, whether it’s a Posey or whether it risks or, um, whether it’s some sort of a, maybe if it’s an elbow immobilizer, if it’s an elbow mobilizer, that thing goes above and below the elbow. So an AC would be a terrible spot to put this in. Now if I’ve got a patient that has wrist restraints, I’m trying to put a hand IV in or where it ends right at the wrist or just right above the risk.

Maybe that’s a bad area. You want to avoid those areas of restraint because are you’re going to do, is your patient’s going to dislocate that IV and now you’ve got to go put another one in. You got to get a bunch of people involved, but that’s just something to consider. Now, the last thing you want to do is deescalate and try to calm your patient. I said that you can’t always get them to, you can’t always coerce your patient into being completely compliant. But what thing you can do is deescalate your patient. And you can talk about calm voice. You can be positive, you can try to positively reward them. Um, but what you can’t do is ever try to get a patient to completely comply. So what you need to do is just try to deescalate, talk in a calm manner and try to get your patient as cooperative as possible.

Sometimes there’s a little bit of bargaining, sometimes there’s a little bit of negotiation, , in terms of getting them going vote. Do what you can to get your patient calm. And also think about this too, is that multiple people could actually make the problem worse. So you want to try to find the minimum. Maybe it’s just one other nurse you need. Maybe it’s one nurse, maybe it’s two nurses, maybe anyone that’s going to distract them and one to hold up to help restrain them. There are lots of different ways to do it but try to get your patient in that calmest state before you even tried to do this. IV. All right, so let’s talk about your IV insertion. You want to set up that routine that we always talk about when we’re doing IVs. We want to get all of our suppliers, we want to get everything and we want to set it up.

That’s the most important. Two things that we got to do. You’ve got to have a good foundation. If I’m trying to reach across the bed and there’s stuff just flying everywhere, then it’s no good. Get your bedside table good. I’ll set up and identify your Bay, your vein, and then you want to apply the tourniquet like we always do. This is where your friends are going to come into your coworkers or your other floor nurses. This is where you’re going to get them to come in and help you. The other thing you want to do is write about in here you also want to get restraints. Um, and my restraints, I mean help. This is what I mean. I don’t mean like, I don’t mean like wrist restraints. What I want is help. I want people to get in there and help me before I need to make sure that I can at least stabilize the location that I’m gonna apply this catheter in and then we can move forward and actually placing it.

But if this, if I don’t have, a solid footing, it’s like trying to shoot a Canon out of out of a canoe. It’s just, it’s, there’s no solid foundation. So getting everything in place, getting everything as calm as possible, getting my friends there to help me calm the patient and keep that arm or leg stable wherever we’re going to go. But that’s going to be another solid point that you need to think about. Get that IV placed and also secure it. And this will, this may take a couple of different methods. You may have to do tape and a transplant dressing and you may have to do a couple of different things, but these are things that I don’t want you to think about is you’ve got to think a couple of steps ahead for these types of patients. Here you can see that the we’ve got a combative patient who’s not cooperating.

The important thing here is that we want to use those restraints if we have an order for them, we want to make sure we’re following policy. But the biggest thing here is we’ve gotten additional nurses in additional staff at the bedside to make sure that the place the patient is going to cooperate. The goal here is to maximize stability for that IV insertion site. Here what they’re doing is they’re actually keeping the patient in a relaxed position as much as possible, even though he looks pretty uncomfortable. But the goal here is again, to stabilize that area and to keep the patient from having his arm flail about to where they could actually cause injury. The process is still the same. You’re still gonna prep, you’re still gonna set up. You’re still gonna place that IV in the, in the exact way that it needs to be placed.

You’re gonna follow all the securing techniques. You’re gonna make sure that’s secure, but the biggest thing you want to focus on here is avoiding areas that are going to create problems. You want to make sure that IV is going to stay in place and Peyton, so we’re gonna, we’re gonna want to avoid areas like the elbow or, um, areas like the risks, especially if there are risks change or if there has to be an oboe mobilizer and making sure all the lines are away from the patient so that you don’t run into any complications with that IV. All right, now let’s recap. Remember, the first thing we want to do anytime we’re dealing with competitive, combative patients is to get help. We want to focus on safety, both the nurses and of the patient. We don’t want accidental needle stick injuries. We don’t want to cause harm to our patients.

We don’t want to injure our patients. We don’t want to have to put in more IVs and necessary because we actually didn’t do the due diligence and getting some help. Maybe it’s one nurse, maybe it’s two nurses, maybe you just need one to talk to the patient and or maybe you need that right nurse to talk to the patient to get them to cooperate. It’s not always a cookie-cutter. And you may need to approach this in several different ways, but always think about safety first for your patient and for yourself. And then have the avoid those restraint areas. So areas like the wrist you don’t want the IV to get caught in wrist restraints. You want to be able to, if you need some sort of an elbow immobilizer, you want to make sure that’s not going to cause any problems with any sort of IVs.

The last thing you want to do is be giving your patients some sort of medication that may cause soft tissue necrosis or damage because we put it in maybe a bad location. So always think about, um, if some sort of restraint is going to cause damage to the IB towards not painting and it’s not working now, lasting, deescalate. Try to calm the patient to improve the cooperation in which you can. Once you get to that point, then you can focus on stabilizing the patient that IV location so that you can get that IV set. All right, guys, I hope that this lesson has been helpful in giving you some tips and tricks on how to approach combative patients and how to get those IV set in them so that you can have better success in your patients, can have more positive patient outcomes. Now we love you guys go out and be your best selves today. And as always, happy nursing.