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Are IVs scut work?

Posted Apr 05 2013 12:00am

Is there educational value to teaching and learning how to place peripheral IVs? Not the exciting central lines, IOs, or ultrasound guided IVs. I am talking about straight forward and routine peripheral IVs.

Or is this scut work?
Can there be any educational value to scut work?

It is easy in a hectic ED to get lost in the sheer amount of work that has to get done during a patient's visit. Labs need to be drawn, EKGs must be performed, radiology images have to be obtained. Not to mention the all important medical decision making processes. These tasks depend upon many people to make happen. In addition to the physician, there's the nurse, phlebotomist, EKG tech, xray tech, lab tech...  so many techs!

I personally feel that learning how to place and master peripheral IVs is a critical skill for an EM physician. We all know about the ABCs... and C stands for circulation, and obtaining IV access is an important part of addressing circulation. The peripheral IV is a core component of our work. We have all been in codes where access isn't obtained, and the IO fails to hit the mark. No one should die without having an IV first.



Another example of "scut work" that I value is the transport of critically ill patients to CT. Why?  Because of the importance of learning how difficult it can be to obtain multiple CT scans on critical patients. Imagine the intoxicated and abusive ED patient who comes with multiple traumatic injuries. We order CTs and expect results to appear in PACS immediately. But how often do you go with the patient and observe how difficult it is to subdue the patient and get them onto the (very narrow) CT table? Or think about the times a critical patient has gone to CT, only to crash without having a physician present? I have gone many times with these types of patients and can attest that it is not an easy job to have difficult patient comply with testing while they are altered. It adds perspective when determining what and how to order exams.


I am not saying we need to be super heroes and accomplish all these tasks alone. That's not realistic, nor a good use of time. However, I do feel that there is value in learning. The ED is our domain, and we should have mastery over all that occurs within it.

What do you think?

Is there value in tasks such as IV placement, accompanying difficult patients to CT, knowing how to obtain an EKG, and other "non-physician" tasks?

Nikita ( @njoshi8 )
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