Jan Wold dreads her monthly visit to the Health Sciences Centre.
The 69-year-old has an immunodeficiency disorder and gets monthly intravenous immunoglobulin, or IVIG, over the course of a morning. She's been going for the past 12 years.
But in October, the WRHA axed a team of nurses devoted to IVs at the same time it came down on a policy that prohibits the use of local freezing prior to IV starts in most areas of the hospital.
"It hurts! It hurts like heck! And you're hoping you've got, now that we're dealing with the regular nurses, you hope you have someone who really can sense what she's doing," she said.
"It's scary, you're nervous ... The freezing made such a big difference."
The veins on Wold's hands and arms are nearly impossible to see and feel as a result of her body's response to chronic IV access, she said. It's a trait she shares with many of the other patients who receive monthly infusions, and why she wants to speak up on their behalf as well.
"Their veins already don't want to co-operate," she said.
"There's the chance that there's going to be a lot of digging and digging and digging, trying to get that needle to connect with the vein. So when you don't have that freezing it's just, grabbing the end of that chair and just hoping it's going to work this time."
What used to be a quick, relatively painless procedure thanks to nurses with IV expertise on the Vascular Access Team has now become a process involving several nurses, several pokes and lots of pain.
"So by the time I get out of there, I am so demoralized, I'm so upset with where we are, and with what's happening, and that this is the way it's going to be for the rest of my life."
She said after her visit in October, the four bruises from the IV attempts took almost a month to fade.
'Close to 2,000 nurses who don't start IVs'
The WRHA eliminated the Vascular Access Team — a group of about 20 nurses who started and maintained IVs at the HSC — in response to provincial direction to cut costs in health care. Even though the remaining HSC nurses scrambled to get certified in the skill before the loss of the team on Nov. 18, the transition has been too abrupt, according to the president of the Manitoba Nurses' Union.
"The whole issue is we have a very large number of nurses who are just getting up to speed on starting IVs so there's not a lot of expertise there in that skill at this point in time," said Sandi Mowat.
"We're talking close to 2,000 nurses who don't start IVs."
While all nurses are trained and certified in starting IVs as part of their scope of practice, Mowat says in some units, nurses don't feel they have enough practice.
She said this past month, several nurses at the HSC have called the union, concerned about a lack of backup after unsuccessful IV attempts. Hospital policy mandates that a nurse attempt an IV twice before passing the patient on to someone else for two more attempts. From there, the nurse can call a resident, a nurse specialized in central line insertions, or the anesthetist.
"Those individuals are not always available when the IV is needed," said Mowat, plus it's traumatic for the patient.
"We can't subject people to all these IV pokes. It's painful and not good for them and they have a large population of people there who have difficult access anyway, so the worry is if you're doing multiple IV attempts and you're not able to establish an IV, that will cause problems, so it's a concern in the long term."
In past interviews, WRHA chief nursing officer Lori Lamont said the IV team cost the equivalent of about nine nurses' salaries.
"It wasn't a huge amount of money. If they adamantly felt they had to do this they should have done it in a more phased-in manner so people had more expertise," said Mowat.
"What it all comes down to is the IV nurses were the experts and all of a sudden we've lost that cache of experts."
Desperate for help before her next appointment, Wold wrote to members of the conservative government, the NDP government and to Liberal MLA Jon Gerrard of her situation.
Gerrard, a former physician who has inserted several IVs, faced off with Manitoba's Health Minister Kelvin Goerzten about the issue in question period Thursday.
Gerrard accused Premier Brian Pallister of cutting the HSC IV team and the use of local anesthetic before IVs to cut costs at the expense of patients like Wold, who has suffered pain and bruising as a result.
"This, quite frankly, is barbaric," he said.
Goertzen countered that nurses at the HSC are trained to start IVs.
"It will now be a 24-hour service where it wasn't a 24-hour service before. When it comes to the anesthesia there's been no change in the policy," countered Goertzen.
But the policy on freezing hasn't been universally followed, stated a spokesperson for the WRHA, and staff were reminded in September and October that local freezing was only to be used before IV starts in the pre-op surgery area of the hospital.
WRHA spokesperson Bronwyn Penner-Holigroski said freezing can actually make it more difficult to find a vein.
Gerrard said ultimately, care should be better than multiple pokes and unnecessary pain for patients — especially those with difficult veins to access.
"It's inappropriate and it's not modern-day medicine for somebody like Jan Wold."
Dreading next visit
Wold agrees, stating that hospital cuts like what happened to the IV team shouldn't physically hurt the patients.
"I think it was done very rashly, without consideration to patients, and patients who might be suffering in pain," she said. Nurses on the IV team would start an IV on the first try "90-95% of the time," she said.
"I've invited Premier Pallister to join me at my next infusion, so he can see what it's like."
While she waits for his RSVP, she said she's dreading the next visit only because of the pain, and not the care.
"I feel the nurses and the doctors are victimized as much as the patients are through all of this. I don't know how they feel to have to add another chore to their daily routine," she said.
Mowat said many HSC nurses are "stressed" over having to poke their patients several times.
"The nurses don't feel good about it. They certainly don't feel like they're giving good patient care."
Penner-Holigroski disputed the idea that some nurses are out of practise in administering IVs.
"In fact, the infusion room nurses start IVs frequently and are arguably experts in doing so; they have been doing so for over a year," she said.
All nurses have received additional training, said Penner-Holigroski, who said having general-duty nurses administer IVs means patients won't have to wait for a member of the IV team.
The Vascular Access Team was one of the last remaining standalone IV teams in Canada and has been converted to a 24/7 centralized line (PICC) service that can also offer support for peripheral IV starts.
Patients like Wold can get a "longer-term" solution to have more comfortable treatments, Penner-Holigroski said, such as a PICC line.
The PICC team can also use ultrasound to insert an IV with less pain, she said.
But the PICC team is made up of far fewer nurses than the IV team and they're not always available, said Mowat. Most of the nurses who were on the IV team are in the process of bumping and finding new jobs, she said.
"There probably needed to be a better plan for transition than just having it all end one day," Mowat said.
"I think in the short term they certainly have to look at developing some expertise and if there's people that are able to do that then we have to use those people."