restarting prehospital IV's

  1. We don't restart them unless there is a need. I have heard that this is a practice others places, but I have yet to find and studies that actually states that IV inserted in the field become infected more often than those put in in the hospital.
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  2. 21 Comments

  3. by   maikranz
    Originally posted by Chris Reardon:
    Our ED just received a memo (from a non-ED staff person in a position of quasi-authority)that we are to always restart all pre-hospital IV's after the pt is stabilized, citng a reference to the Intravenous Nursing Society. This despite the fact that we have absolutely no epidemiological data in this facility to indicate there is or ever was a problem with infections. In fact, no nurse I've interviewed here -- and this covers 15 years of experience -- has any recollection of an IV that became an infection problem due to the mere fact that it originated in the field. So, I pose this question to allof you out there: is this rigid policy something that's considered the standard of care everywhere else but here; and if so, how do you reconcile (in the absence of a demonstrable problem specific to your institution) the extra expense to the patient, the pyschological trauma you'd potentially inflict on pt's with a dread of needles, needless pain, etc? I'm serious! We work in a a very rural area, and maybe we're lost in the woods here! What's the truth??? Thanks!
    'evening.
    Unless there's a problem with either the line or the site, we don't bother until it's
    time for the site to be changed. I'd (1) get a copy of the article or the reference and
    (2) "...how do you reconcile the extra expense..."? it sounds like a perfect
    nursing research idea. Good luck
  4. by   Chris Reardon
    Our ED just received a memo (from a non-ED staff person in a position of quasi-authority)that we are to always restart all pre-hospital IV's after the pt is stabilized, citng a reference to the Intravenous Nursing Society. This despite the fact that we have absolutely no epidemiological data in this facility to indicate there is or ever was a problem with infections. In fact, no nurse I've interviewed here -- and this covers 15 years of experience -- has any recollection of an IV that became an infection problem due to the mere fact that it originated in the field. So, I pose this question to allof you out there: is this rigid policy something that's considered the standard of care everywhere else but here; and if so, how do you reconcile (in the absence of a demonstrable problem specific to your institution) the extra expense to the patient, the pyschological trauma you'd potentially inflict on pt's with a dread of needles, needless pain, etc? I'm serious! We work in a a very rural area, and maybe we're lost in the woods here! What's the truth??? Thanks!
  5. by   CEN35
    Our hospital policy is that all squad IV starts be DC'd within 24 hrs d/t increase risk of infection. I think this policy was devised because of the potential for dirty sticks in the field, such as an entrapped person in a car, where being clean is not really possible. Thing is? If there is enough room to move around and start and IV on a patient, I have too assume there is enough room to clean the site well enough at 1st. Besides, I can only assume that if the site was unclean? It wouldn't matter how long it was left in, the pt would get an infection.

    CEN35
  6. by   cmggriff
    I saw this policy instituted at two hospitals in the past. The bottom line is money. The hospital cannot charge for an IV start if there wasn't one. If the hospital owns the ambulance service too, as one of the hospitals i worked at did, it can charge the same patient twice.
  7. by   moonshadeau
    Many of the nurses at the hospital I work at like to restart a field IV's and even other facilities IV's that have been transferred to us. Most of the time, I see that a patients antecubital is used for a field start and most patients complain of the IV irritating while doing their ADL's. The antecubital IV's seem to not work quite as well with patients and pumps for us. Also, the reason why we change IV's is because there isn't a universal IV kit that is not always compatible with the equipment that we use. I still see people come in with metal iv's.
  8. by   cbuttonrn
    The standard of changing prehospital lines is actually an APIC (Association of Proffesionals in Infection Control) standard. I'm on Temporary duty in the Air Force right now and don't have access to the references. It is in the 2000 APIC manual. As soon as I get home I'll get the correct references.

    Check with your infection control office, they should have the correct references.
  9. by   ufmedic
    Annals of Emergency Medicine (OCT 1996) found that pre-hospital IVs had a lower infection rate than hospital initiated IVs. There are several studies that say differnt things; however, the technique for IV starts by paramedics is identical to the technique used in the hospital. As for statrting them in a dirty environment, it is true that occasionally EMS will start a line on someone trapped in a car, but most pre-hospital IVs are started in the ambulance and the ambulances are cleaned top to bottom with bleach/water on a daily basis.
  10. by   UM Review RN
    We're required to change any field sites within 24 hours, citing infection risk as the reason.
  11. by   ERNURSE4MS
    We don't restart unless there is a problem with the site( infiltration or redness) Our policy is if site prep is alcohol restart in 72 hrs, if prepped with chloraprep then restart in 96hr. I have not seen any infections related to prehopital IV's. The only problem I have seen is infiltration with is understandable in a trauma pt or combative pt.
  12. by   mattsmom81
    If the ambulance workers use the same aseptic techinique and occlusive sterile dressings I too have always questioned this 'rule' ...every hospital I've worked at has a policy to restart field IV's ASAP...I assumed it was for liability reasons. Maybe $$$ as well. I've always hated wasting a good IV site specially if the patient hasn't many.
  13. by   VivaLasViejas
    Quote from mattsmom81
    If the ambulance workers use the same aseptic techinique and occlusive sterile dressings I too have always questioned this 'rule' ...every hospital I've worked at has a policy to restart field IV's ASAP...I assumed it was for liability reasons. Maybe $$$ as well. I've always hated wasting a good IV site specially if the patient hasn't many.
    Me, too, in fact there have been a number of times when I've NOT changed them because the patient has few viable veins or has already been through a lot of trauma and doesn't really need to be poked again. However, I do document it, along with the rationale for deferring the change to another day or time according to my nursing judgment. That way, if something should go wrong with the site later, at least I've covered my own assets by documenting that there were no compelling reasons to change it at the time I assessed it. (So far, this has never happened......but I figure there's always a first time.)
  14. by   live4today
    Every hospital I've ever worked in stated to change field IV sites within 24 hours, but if the patient is coming from another hospital with an IV already in place there is no need to change the IV site as long as it is patent and intact without any infection noted around the site and so forth.

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