IV insertion is inserting a needle into a peripheral vein to administer fluids, medications or blood. IV allows venous access also to enable sampling of blood, parenteral nutrition and chemotherapy.

A nurse must be ready for challenges that occur during IV insertion and build skills to overcome them. One of the difficulties that they encounter is patients with moderate to severe fragile veins. Some patients also have thin, dry skins complicating insertion further and increasing the risk of injury as well as susceptibility to infection. Many instances will require IV insertion and the patient trusts you as the nurse to insert without complications. Nurses should develop tips and strategies to insert an I.V device without causing harm to the patient.

1.Apply only minimal friction

Avoid applying too much friction as you prepare the skin if it fragile due to factors such as age. Too much friction on a sensitive skin might damage the surface tissues and put them at more risk of bacterial infection.

2.Avoid tourniquet much as possible

Do not use a tourniquet to facilitate IV insertion in a patient with very fragile veins unless it is vital. It is essential to be careful when handling older patients because many of them have dilated veins and tourniquet in such instances should be out of the picture. Choose light material tourniquet if it is necessary to use it. Apply it lightly but remove son after you notice some backflow of blood in a cannula. Improper use of a tourniquet on a patient with very fragile veins may cause venous "blow," skin damage and formation of a hematoma.

3.Use the smallest size of catheter available

The type of therapy that a patient should receive determines the gauge of a catheter to use for IV insertion. Nonetheless, health practitioners should choose the smallest size available to prevent possible damage in patients with fragile veins. The standard practice for IV therapy is that patients with delicate veins according to infusion nurses society should only get gauge 22 or 24. A catheter that is too large for vessel lumen can cause irritation as well as mechanical phlebitis and possible thrombus formation.

4.Insert the catheter slowly

Inserting an IV device for patients of all ages should be slow and steady. There should be no rush when inserting. You should use a bevel-up approach to slowly insert the needle on top of a vein to ensure that it stays stabilized. Try to keep it almost flat with a patient’s skin or at an angle of 20 to 30 degrees. Start by penetrating the vein with a single short stroke then slowly advance the needle and cannula. It is essential to begin by determining the proper needle-skin angle to use and provide good skin traction for stabilizing the vein before you proceed to IV insertion. You should from here use a bevel-up approach by slowly inserting a needle on top of a vein making an angle that is almost flat with the skin especially for dilated veins that are visible through the skin surface. You should take your time to insert to avoid causing more damage and harm to the veins.

5.Use a paper type tape to secure the catheter.

Dry skins can get unnecessary damage if you use silk or plastic adhesives for securing the IV catheter. Paper-type tapes are the best method to maintain IV safe insertion for patients with unstable veins and sensitive types of skin. Use an adhesive solution to simplify the process of removing the adhesive with ease and without causing more damage to the skin.

Some factors can make a vein to be too fragile to pass an IV catheter. Aging, use of illicit drugs, long-term use of particular prescription drugs, heredity and exposure to UV rays are among the factors that cause fragility in a vein.

It is impossible to change the state of a vein immediately hence the need to use the above strategies to make it simpler to perform IV insertion. A long time measure is to educate the patient on how to improve the condition over time. Patients can reduce and prevent veins from becoming fragile by these ways;

Practice and learning how to perform IV insertion on very fragile veins simplifies nursing work .it also reduces discomfort and risk of infection to the patients.

The term non-compliant patient refers to someone who does not take medicine according to prescription or fails to follow the prescribed course of treatment. The failure to comply can sometimes occur because the patient refuses to adhere to instruction by a healthcare provider.

It is difficult to deal with non-compliant patients due to the frustration of trying to help someone who has no concern about the effort and danger of failing to take medication according to prescriptions. Those who are not careful can lose their professionalism and rationality making it even harder to convince a patient on the need of compliance. An individual who is non-compliant feels more powerful and in control of the verbal interaction if the caregiver becomes emotional.

1.How to Deal With Non-Compliant Patients

The first thing by a professional who is dealing with a non-compliant patient is to make the person understand the dangers of deviating from instructions by a medic. It is a bonus to make the person comply. These approaches guide professionals to deal with non-compliance.

2.Determine the reason for non-compliance

It is simpler to find a solution for a patient has a reason for failing to comply than someone who is adamant. Nursing is a resourceful profession and the training together with experience can yield to alternative solutions.

Here are the frequency reasons for failing to comply with medical instructions that enable a nurse to determine if a non-compliant patient requires help or is just stubborn.

Other patients will stretch patience because they fail to comply deliberately and are unlikely to meet for these additional reasons:

After determining the reason for non-compliance, these steps will help to manage the patient especially when failure to comply was a stubborn action.

3.Maintain rationality

It is essential to stay rational because losing your cool will cause a power struggle that does not guarantee a win by persuading the patient to change. An increase in frustration and irrationality by a professional makes the non-compliant patient more stubborn.

4.Explain the directive

Sometimes it might be wrong to assume that a patient knows the meaning of medical instruction. It might be that the person does not understand and deserves the benefit of a doubt by clarifying the importance of a medical directive.

5.Place responsibility at the rightful place

The responsibility for refusing to comply with medical directions should lie with the patient, and a caregiver should not agree to shoulder the burden. For instance, a patient can insist on knowing the ways that a nurse can use to cause compliance. It is essential to inform him that there is no action to enforce submission but explain the medical consequences of failing to take medications or treatment and then he will carry the blame for the inaction.

6.Set reasonable limits

Some non-compliant patients want to test the ceiling to see if the healthcare provider will budge and change the original instructions on medication and treatment. Setting reasonable limits and consequences is essential. The person will think that nothing will happen if he limits are unreasonable. You should be ready to enforce some results when setting the boundaries. The action could be something simple like telling the patients to leave the room, or you get help to remove them if they are not going to comply with treatment or medication recommendations. Enforcing the limits makes it simple to manage such persons in future because they know you will take action if they are unreasonable.

Charting and documenting when dealing with a non-compliant patient is very crucial because it will provide evidence if there is a future inquiry about a failure to complete treatment. It feels great when those who know how to deal with non-compliant patients succeed in changing their attitudes. However, it should not be a reason for self-blame when patients choose not to comply after an explanation on the need to change their stubbornness.

Self-diagnosis is a process by a patient to identify a medical condition without seeking medical help from a professional. The diagnosis could be from the knowledge that a person learns by reading medical resources on the internet, books, dictionaries or past personal experience. Other diagnose by identifying similarities in symptoms and medical signs to those in family members or friends who are suffering from a condition.

Nurses should accept that self-diagnosis is now a reality in the medical field. The most challenging aspect of managing patients who self-diagnose is to establish trust and a rapport. It is clear that such patients have meaningful information about infections that they learn from discussions with other people, the internet or publications. It is essential to develop strategies that simplify the management of a patient who self-diagnose if you are a nurse or healthcare provider.

Tips To Manage Patients Who Self-Diagnose

1.Acknowledge the efforts by the patients

The first step is to make the patients who self-diagnose to feel that you appreciate their knowledge. Healthcare providers should get into the shoes of such patients to better understand what they are going through and to determine the better solution. Patients feel that someone is giving them the importance and validates their effort by acknowledging the trouble they took to research on their symptoms to the point of achieving a diagnosis.

2.Strike a friendly conversation

Communication is essential for an excellent healthcare provider-patient relationship. It is vital to approach the situation delicately even if a patient diagnosis is inaccurate. Start by acknowledging the valiant effort in an attempt to diagnose, articulate the correct diagnosis and demonstrate the common understanding. Explain the concept of differential diagnosis that occurs when different illnesses or injuries are present and show similar symptoms if applicable.

A friendly approach recognizes the effort of a patient is self-diagnosing but corrects the wrongs without arrogance or belittling the person. This method of dealing with a patient does not entirely discredit the self-diagnosis but states the similarity of symptoms between the wrong self-diagnosis and the correct diagnosis. Approaching the situation with an understanding enables a healthcare provider to develop trust and better rapport with a patient.

3.Encourage verbalization of the feelings

Patients tend to listen to, and trust medical staff who encourage a verbalization of their feelings and listen to them .It also helps to establish a rapport that makes a patient reveal information concerning self – a diagnosis which is helpful in narrowing down to a better potential diagnosis.

4.Build on the shared information

The information by a patient provides an excellent opportunity to find something relevant from their symptoms if you can take time to achieve a good grasp of the things that a patient believes and understands. It is best to build on the information that patients share when it possible to add on to what you know about the symptoms and correct diagnoses.

5.Suggest extra resources to guide the patients

Providing additional information increases knowledge by the patients and might guide them to correct some false assumptions. Health experts should advise the patients to find information from websites and other resources affiliated to healthcare institutions and medical centers to access more accurate facts on self-diagnosis. Data from such locations has undergone a thorough examination before publishing to ensure that they carry the most accurate and up-to-date information. It is vital to inform the patients that they should avoid sites that have excess adverts because the writers may have edited the information to meet requirements that favor the advertisers.

6.Educate the patients about dangers of self-diagnosis

More people are spending time on the internet finding information about medical conditions and some might assume that they are masters of their health. Healthcare providers must diagnose, treat and also educate the patients to prevent mistakes in future. Healthcare providers must act as the patient's advocate after assessment and diagnosis. It makes it part of their duty to inform the patients about the pros and cons of a self-diagnosis.

If possible, you should provide visual aids for the patients to achieve a better understanding of the things that they might experience when something about their diagnosis goes wrong. Patients who get accurate information from their care providers will minimize reliance on the internet and other media for self-diagnosis.

A critical care nurse (CCN) is a nurse with specialized training, knowledge, and skills to provide care to acutely ill patients. A CCN offers care to patients with healthcare demands that require close monitoring. A critical care nurse should take care of 1-3 critically ill patients at a time in an intensive care unit (ICU), but this is just an ideal number. The number of patients can increase beyond the three especially at places where staff shortage in rife. Someone who wants to offer critical care nursing should follow specific steps to attain the position.

Steps to Becoming a Critical Care Nurse

Enroll for a nursing program

The first step is for nurses to finish the nursing studies to become a registered nurse. It is a prerequisite requirement for critical care nurses to be registered nurses before they enter this specialized field of nursing. Most employers prefer critical care registered nurses (CCRNs) with a Bachelor of Science degree in nursing. Some start by getting an Associate's degree level, but it is essential for nurses who want to be CCNs to consider academic qualifications before writing their applications.

Obtain licensing to become a registered nurse

Each state has it set of requirements for nurses to earn their registered nurse license. It is essential to visit the state board of nursing website at the state where you plan to practice and determine the eligibility requirements. Nurses obtain a license to practice after passing NCLEX-RN the (national council licensure exam for registered nurse).

Earn the relevant experience

Critical care nursing requires certification that nurses can only get if they have particular expertise in a critical care field. The period to gain experience in intensive care settings is also an opportunity for exploring desires to become a certified critical care nurse. Experience in critical care nursing is somewhat significant because it is a requirement that a nurse must fulfill before obtaining a CCRN certification.

Get a Critical Care Registered Nurse Certification

Nurses who pass the licensure exam to practice become eligible for CCRN certification. Certification is not a requirement to work in the critical care settings, but many nurses in working environments choose to get CCRN training and credentials that they get through professional associations such as American Association of Critical-Care Nurses (AACN) in the USA.

CCRN-E certification is available for registered nurses who work are roles where they monitor the critically ill patients through technologies from remote locations and cameras. CCRN certification is also available to those working in critical care environments and issues, but they do not provide direct patient care.

Nurses who take the AACN route provides training and certification test to RNs aspiring to become critical care nurses in the neonatal, pediatric or adult field. A nurse can fulfill the requirement by AACN for CCRN certification by choosing one of these options:

1.1,750 hours experience working as an APRN or RN offering direct care to acute/critical patients for the past two years. 875 of these hours should be from the most recent year before application.

2.Five years experience that includes a minimum 2,000 hours to work directly with the critically or acutely ill patients. I44 hours should be in the most recent year before the application.

After determining the eligibility, AACN informs the applicants about the fee they should pay to take a computer-based exam and get a CCRN certification that is valid for three years after passing the examination.

CCRN Recertification for a Critical Care Nurse

CCRN recertification takes place three years after getting the first certification. CCNs should apply for recertification to maintain their eligibility for the role. Those applying to for recertification should have these qualifications in place.

1.Experience of 432 hours or providing direct care to critical/acute patients during the three-year certification period. 144 of these hours should be in the past 12 months before the renewal date.

2.100 units of Continuing Education Recognition Points in three categories covering areas of caring practice, diversified care, collaboration, and clinical inquiry.

3.Recertification candidates can also use the option passing a renewal exam instead of obtaining the 100 units of CERPs above.

Critical care nursing is a specialty that healthcare professional regard as a valuable practice in caring for patients with acute illnesses. It is a hectic career that suits staff nurses with interest to specialize in a high charged nursing specialty.