Do you stop infusion "for a walk?"

[rkitty198]

"I want to go for a walk and a shower," "will you unhook me?"

Do you stop the IV infusion to allow the patient some freedom?

Times where it really bothers me:

-Patients who are on PCA's who want to go out to smoke (which we have sign a consent for leaving the building).

-Patients who need an IV abx and will have treatment delayed until they are ready.

-Those who have peripheral IV's which end up infiltrating, leaking or falling out which adds more time to my day because I have to put in another IV, which then delays more treatment.

-I am stopping an infusion which is a doctors order

-I have to get back into the room asap to restart the infusion (PCA's, ABX) because going for a smoke puts the patient in a pain crisis and then suddenly they need their PCA again.

(by the way, we do give nicotine patches for those who smoke, and we have them sign a consent when they leave the floor)

What is your practice?

I am starting to think about saying "no."

[Jenni811, RN]

Call me nurse cratchet but i still won't unhook!! Honestly, i would not want to risk anything happening for the sake of making my job easier by walking them without a pole to worry about.

Yea...they are a pain in the butt and the wheels get caught on every bump, but i would not risk anything. It is not worth it.

I don't even give the patient an option for it to be off. If they are getting in the shower i say "This is the shower glove you must wear over your IV site so it does not get wet"

If we go for a walk i say "When you are ready for your walk, let me know and i will help you with that IV pole"....OR i say "You can take your walk now with your pole, or we can wait till i have the orders to disconnect it" (usually only say that if i know doctor will be discontinuing fluids).

Not giving patients options with certain things like this actually works! THe only time it doesnt work is if you have a nurse for a patient (they are the worst haha)

[psu_213, BSN, RN]

I don't even give the patient an option for it to be off. If they are getting in the shower i say "This is the shower glove you must wear over your IV site so it does not get wet"

If they are going in to the shower they need to have the site covered with a glove, etc. even if it not infusing anything and it is just a saline lock...

The other thing I must wonder is why so many people think it a huge infection risk to disconnect fluids for trip to the BR, shower, walk, etc. As I said before, If the tubing is properly capped and the lock is scubbed with alcohol before hooking the fluids back up, why is it a big deal?

[noyesno, MSN, APRN, NP]

If they are going in to the shower they need to have the site covered with a glove, etc. even if it not infusing anything and it is just a saline lock...

The other thing I must wonder is why so many people think it a huge infection risk to disconnect fluids for trip to the BR, shower, walk, etc. As I said before, If the tubing is properly capped and the lock is scubbed with alcohol before hooking the fluids back up, why is it a big deal?

I'd be interested to read some evidence base research on infection risk related to frequent unhooking. Right now, I'm thinking it would increase the risk but I'm honestly not basing my opinion on any facts. Just thinking the more often the IV is disconnected the more opportunity for germies to make an appearance where they don't belong.

Anyone read any studies on this?

[MunoRN, RN]

We do know from other research that it's best to leave a closed system closed. Quantifying that risk related to IV infusion systems is not something we have any current data on. In terms of peripheral IV's, we don't even have accurate data on the rate of CRBSI's much less how manipulating those connections affects infection rates. This is because the rate of peripheral IV CRBSI's is currently considered undetectable. All we know is that it's lower than central line CRBSIs which is currently 1.5 per 1,000 catheter days and is the only type of CRBSI that is tracked.

If you look at studies that provide contamination and/or infection rates that also indirectly include varying frequency of connection manipulations, most show no statistically significant increase even in central lines. There are 3 that I know of that do, and the largest increase in contamination rate of those 3 is from 0.9% to 1.1% when there was one additional disconnection/connection over a 48 hour period. This study was from 1984 and it's unlikely that it applicable today, plus if it's infection rates and not contamination rates you're concerned with then that number becomes even more insignificant.

The "I never unhook" mantra is overly-simplistic and I really hope nurses who make those statements don't view everything other decision process in nursing as being that lacking in complexity. I wouldn't routinely unhook patients, but at the same time I wouldn't routinely keep them connected regardless of other circumstances. There are times where there is a legitimate safety concern, I know of an open heart patient who may not have fallen and definitely would not have had his RIJ introducer rip out in the fall dumping out a liter of blood and dissecting his IJ had he been disconnected. The importance of activity also needs to be considered. There is abundant evidence that activity improves outcomes, although even if it's just to alleviate boredom I don't agree that refusing a patient's request to be disconnected is always appropriate. If you really feel you need an order, then call. If a patient requests to be disconnected, explain the rationale for not doing so. If the patient is capable of decision making and still wants to be disconnected because they don't feel comfortable or safe walking with the pole, then you need to disconnect them, telling a patient they have to stay in bed because they don't follow your advice strikes me as a little abusive. (Flame away).

[Jenni811, RN]

If they are going in to the shower they need to have the site covered with a glove, etc. even if it not infusing anything and it is just a saline lock...

The other thing I must wonder is why so many people think it a huge infection risk to disconnect fluids for trip to the BR, shower, walk, etc. As I said before, If the tubing is properly capped and the lock is scubbed with alcohol before hooking the fluids back up, why is it a big deal?

I'm not stupid, i know that it needs to be covered even on saline lock. But i'm just telling them that i'm not going to unlock it.

Im just saying i won't do something i dont have an order for . End of discussion.

[MunoRN, RN]

The patient has the right to refuse any treatment. If the patient wants an infusion stopped then you don't need an order, you should explain to them the purpose of the treatment and you can notify the MD of the patient's refusal, but if they are capable of medical decision making then you must stop the infusion, regardless of whether or not you have an MD order.

[psu_213, BSN, RN]

I'm not stupid, i know that it needs to be covered even on saline lock. But i'm just telling them that i'm not going to unlock it.

Im just saying i won't do something i dont have an order for . End of discussion.

Would you like to show me the post where I called you stupid?

I do find it interesting that you decided unilaterally that the discussion is over and your viewpoint is the only one that matters...

[Up2nogood RN, RN]

I agree with some prev posts about unhooking for certain circumstances. Definitely if a confused pt is at risk for pulling their central line out due to the ivf hooked up. Or a pt who wants to shower and has drains up the wazoo, then yes too. For Mrs. Jones who wants to be unhooked for every bathroom trip, walk, to brush her teeth and the IV in her hand is just too inconvenient, No I won't unhook. Honestly I rarely even get asked maybe because I don't offer to unhook, work nights, and/or they're just too plain sick to care.

[Up2nogood RN, RN]

I'm not stupid, i know that it needs to be covered even on saline lock. But i'm just telling them that i'm not going to unlock it.

Im just saying i won't do something i dont have an order for . End of discussion.

Do you really have to have an order for that? I thought we could use our *nursing judgement* on things such as unhooking IVF's for a shower, at least we do in my hospital. Maybe it's different for others?