IV in AC - page 3

Anyone else frustrated by getting patients from ER with IV's in the antecubital? Nine times out of ten we have to pull them and restart the IV. Patient's don't like them there and can't bend their... Read More

  1. by   P_RN
    Ridiculous and scarey that there are nurses who think like your above post.
    Remember debate the topic NOT the PERSON.....keep to the subject.
  2. by   dphrn
    The only thing that comes to my mind is:


    W O W !!
  3. by   moia
    I actually have worked so far..heh..er and CVICU and now as I am a broke down nurse on the IV team.
    The AC is a truly crap spot for an IV. It is only good for a patient that is alert and cooperative. It is HELL when they are combative traumas and they wont keep their arm straight and the IV keeps stopping and finally you end up tying them down.


    The absolute best spot for a huge monster is the back of the forearm...you have to put the iv in standing a bit backwards and it takes some practice and a little gymnastics but wow..it's comfortable for the patient and it's huge!!!
    Guys seem to always have this monster vein that no one ever touches...it is rubbery and you must absolutely go really big...no 22's here..you will just bounce off.

    The AC never lasts..it clots off right when you need it most or they put a 20 in and it infiltrates....a trick for when you MUST go antecubital...go high or go low...follow the ac up or down and then measure out where the catheter is going to end up...try to insert so the catheter doesn't get caught in the bend...it takes another moment of your time to feel where the ac comes in and goes out but it is worth it.
    Even on the floor you can go ahead and try this...go as low as you can following the downword route of the ac...guarantees you nice big vein,,stable too.
    You never have to stick right into the ac except when patients are circling the drain.


    I too am happy when any patient arrives with any IV anywhere.

    What I really hate......nurses who call the IV team to resite an IV without making one attempt to try themselves...every employee of my hospital was trained to start IV's...it was a really big deal..the nurses demanded it...it was "their practice" whine whine whine... call the union whine whine lots of snide comments to IV team members what are you going to do for a job when we start our own IV's? then the day came when they had to start IV's....oh well we don't have time...we don't have experience...don't we have nurses for that?
    They fired the IV team...we are talking about a level one trauma center and heart center....big scramble...one IV nurse for days,one for nights...70 Ivs a day..50Iv's a night....floor nurses WONT start IV's at all
    2 Iv nurses on days..one on nights...IV starts going crazy

    Guess what...hospital scraps all Iv training for RN's...they aren't expected to do them anymore...except in the units and er.
    Still I meet some who come with me for the start and I teach and they learn and I let them follow when they have time to get a little practice in...its funny but it is usually the older nurses or the brand new ones who want to come along.

    I have worked many nights in the er and honestly I can say I have almost never put an Iv in the ac...there are easier spots and when patients are fighting getting into the ac is impossible but you can get into their forearm with some help.
    A lot of our paramedic staff are trained to go immediantly for the ac so many of our patients arrive with sited IV's and thank god for them.
    All our trauma's or criticals come with IV's and the majority are ac's...I can't complain as honestly I don't think I could start an IV in a moving vehicle with a critical patient.

    Though I have to admit we have to resite alot...Iv's started under those circumstances usually don't last very long.
  4. by   Rena RN 2003
    If I put one in there then the pt either needed it quick, or was volume depleted, or it was necessary for certain CT sudies.


    and CT is the main reason i go AC. come in with c/o belly pain? at least a 20 in the AC. and i hazard a guess that at least half of my admissions are belly pain. if you have belly pain, you are likely to have either a CT or a surgery in your future.

    come in with c/o chest pain? yep, you got it, at least a 20 and preferably an 18 in the AC. if you are going to need cardiac meds quicking, you're getting it in the AC.

    come in with c/o headache? yep, you're getting the big ones. because if you turn out to be a bleed ........ well, enough said.

    when i get a patient, i don't know what is going on with them so i have to assume the worst. chances are when that patient hits the floor we know whether or not that large bore needle was truly necessary. better safe than sorry, imo.
  5. by   Jay-Jay
    As a homecare nurse, I find that patients being discharged home with saline locks in situ generally have them in the hand. Now, THAT is a lousy place for an IV for a patient who's up and about! They're using their hands a lot more than someone who's confined to bed, it hurts more, and the site is usually gone south within less than 24 hours, if not immediately. The worst, though, was the elderly patient (on Coumadin, of course!) who they sent home with an IV EXACTLY where his wrist flexed. What was the problem? Well, he used a walker to ambulate. Try doing that without bending your wrist. The site was blown by the time I got to him to hook up his IV abx, and I couldn't get it restarted, because his veins were so fragile. Eventually, I had to call in another nurse to help, and fortunately, SHE was able to get it.

    Another pet peeve? The ER's that just cap a cannula off without putting on an extension tube and clamp to make it into a saline lock. Um...hello? What's going to stop it from clogging up with a blood clot? And you KNOW (or should know) nurses in the community all use the Interlink system. So, could we AT LEAST have an Interlink cap, or something with a luer lock on it, instead of that hard rubber cap that is NOT compatible with any of our syringes or Interlink needles? Thank you! You see, I really DO want to get home before midnight tonight....
  6. by   missmercy
    I agree that the AC is probably not the most comfortable site for an IV long term, they do sometimes get positional due to the flexing and extending that naturally occurs there -- however, I also know that the AC is a good vein to run things fast and furious through, and it is usually easy to access -- even in stressed situations! We, like others have stated, use them until they don't want to work any longer and then we move them. No big deal. I do agree that it would be greatly appreciated if there were an extension at the site as opposed to merely a hub -- makes life easier for all.
  7. by   RN34TX
    Quote from psychomachia
    Just goes to show you can't please all the nurses all of the time...

    But I'll take a chance and offer my "enlightening" reasons why the AC is sometimes the site of choice:

    1. Easy to start when you're behind and up to you a** in patients who all think their "emergency" is the ONLY emergency in the place.
    2. Some pt.'s actually prefer them since they may not hurt as much as some tiny little hand/wrist vein...to each his own...
    3. When you have to draw your own labs (unlike most floors) you can't fart around trying to suck blood out of some 22g in a micro hand vein, just to have to do it over again when the lab calls and says "it was hemolyzed."
    4. We often don't know what is really wrong with the pt, so a "good" line that is capable of whatever (meds/fluid/blood) we need it for and able to handle any amount is often started. Sorry if that doesn't fit in with your plans.
    5. It gives us a way to get back at the floor nurses who seem to always be on break and "off the floor" when it's time for report from the ER. Who watches your pt.s when you're gone?? And why can't they take report when you're gone?? Perhaps if the floors stopped playing games with their census (funny how so many beds open at shift change), then maybe we would try a little harder to make your life easier...

    Some of the above is in jest; some is not...

    I'll let you decide which ones are/aren't.
    A little off the subject, but I loved your comment about census games!! Since when has it become acceptable to refuse to take report because it's change of shift or the nurse is on break? I take report for other nurses when they are tied up. If I didn't ask all of the questions that the admitting nurse wants, she or he can call the ER back and ask.
    I read the comments about AC IV's and I hate them as well and never could figure out why the ER loves to start them there but it makes a little more sense to me now.
    But still...I've never worked ER, only ICU and maybe this is an ignorant statement due to the fact that I'm not an ER nurse but I have to say it:
    Little tiny 22g IV's in the hand??
    ATTENTION ER NURSES:
    The AC is not the only place you can stick an 18 or 20g needle!! You're ER nurses for crying out loud, you should be good at IV's and not have to default to the AC every time. And yes, it would be nice if you thought about more long term use of that IV rather than your fluid bolus before you send them up to us.
    There, I feel better now. A little immature, but better.
  8. by   BittyBabyGrower
    ATTENTION ER NURSES:
    The AC is not the only place you can stick an 18 or 20g needle!! You're ER nurses for crying out loud, you should be good at IV's and not have to default to the AC every time. And yes, it would be nice if you thought about more long term use of that IV rather than your fluid bolus before you send them up to us.
    There, I feel better now. A little immature, but better.
    That reminds me of the peds floor nurses that beg us to come up from NICU and start IV's and then gripe about putting them in a baby's head! Hello...you used up all the other available space! But, heck we are NICU nurses and we should be able to get an IV anywhere, right?
    Last edit by NRSKarenRN on Jun 21, '04
  9. by   tiredfeetED
    Quote from Jay-Jay
    As a homecare nurse, I find that patients being discharged home with saline locks in situ generally have them in the hand. Now, THAT is a lousy place for an IV for a patient who's up and about! They're using their hands a lot more than someone who's confined to bed, it hurts more, and the site is usually gone south within less than 24 hours, if not immediately. The worst, though, was the elderly patient (on Coumadin, of course!) who they sent home with an IV EXACTLY where his wrist flexed. What was the problem? Well, he used a walker to ambulate. Try doing that without bending your wrist. The site was blown by the time I got to him to hook up his IV abx, and I couldn't get it restarted, because his veins were so fragile. Eventually, I had to call in another nurse to help, and fortunately, SHE was able to get it.

    Another pet peeve? The ER's that just cap a cannula off without putting on an extension tube and clamp to make it into a saline lock. Um...hello? What's going to stop it from clogging up with a blood clot? And you KNOW (or should know) nurses in the community all use the Interlink system. So, could we AT LEAST have an Interlink cap, or something with a luer lock on it, instead of that hard rubber cap that is NOT compatible with any of our syringes or Interlink needles? Thank you! You see, I really DO want to get home before midnight tonight....
    If im not mistaken when someone is discharged who needs IV meds they usually come off the floor??? Where is there PICC?
    When puting in a line my attentions are to get a quick line in that will hold up for a few days..if i do have the time i will hunt down a ext. tube to make a j-loop. And when looking into my crystal ball, I see this person is going to need heavy meds for along period of time..ill ask for a triple lumen....but not likely.
    Even if you have a j-loop you still need to routine flush those lines to keep from cloting, exp without hep-flush. And Interlink cap. ( We use what we have)
    And that frail elderly person on coumadin had a line in there hand because the person starting it ran into the same problem you did!!! lack of good veins! No matter where that line will be..it must be watched close those will infiltrate in AC, Forearm, ETC. and wont alarm the pump! Damn i love the ER!
  10. by   tiredfeetED
    Quote from RN34TX
    A little off the subject, but I loved your comment about census games!! Since when has it become acceptable to refuse to take report because it's change of shift or the nurse is on break? I take report for other nurses when they are tied up. If I didn't ask all of the questions that the admitting nurse wants, she or he can call the ER back and ask.
    I read the comments about AC IV's and I hate them as well and never could figure out why the ER loves to start them there but it makes a little more sense to me now.
    But still...I've never worked ER, only ICU and maybe this is an ignorant statement due to the fact that I'm not an ER nurse but I have to say it:
    Little tiny 22g IV's in the hand??
    ATTENTION ER NURSES:
    The AC is not the only place you can stick an 18 or 20g needle!! You're ER nurses for crying out loud, you should be good at IV's and not have to default to the AC every time. And yes, it would be nice if you thought about more long term use of that IV rather than your fluid bolus before you send them up to us.
    There, I feel better now. A little immature, but better.
    That reminds me of the other day when i sent a patient to the TELE floor with a 18 ga. in the hand...They said i was mean...They will thank me later when there pushing D50, Atropine ETC....lucky i couldnt find any 14 ga..laying around! I like the comment "You're ER nurses for crying out loud" Your Damn right!!! Everyday im amazed at the talent of coworkers with a 18 ga. ..and shake my head at some others!
    I applaud you for taking report for your coworker! sometimes when i get the lunch, busy comments...i wonder where the Teamwork on the floor is...Thats another reason i love the ER...
  11. by   rollingstone
    ED nurses put IV's in the AC because it's usually the most visible and best vein. Experienced nurses can access this site fast which is a plus if you work in ED. When I receive a pt from the ED and they have an AC IV I'll ask if they'd like it removed and the IV restarted in a more comfortable spot when I've got a couple of minutes to do so. Not a big deal for me. I'll do what the pt wants.
  12. by   Jay-Jay
    Quote from tiredfeetED
    If im not mistaken when someone is discharged who needs IV meds they usually come off the floor??? Where is there PICC?
    Nope. Most commonly in the community, our abx. patients have cellulitis. Their PCP sends them to ER, they get one or two quick doses of Ancef, and are d/c home with a saline lock, and orders for Ancef via CADD pump Q 8h X 3 days (7 if the cellulitis looks really nasty.) And yeah, I'd LOVE to see a PICC line, but generally only the Ca. patients get them.

    When puting in a line my attentions are to get a quick line in that will hold up for a few days..if i do have the time i will hunt down a ext. tube to make a j-loop. And when looking into my crystal ball, I see this person is going to need heavy meds for along period of time..ill ask for a triple lumen....but not likely.
    Even if you have a j-loop you still need to routine flush those lines to keep from clotting, exp without hep-flush. And Interlink cap. ( We use what we have)
    And that frail elderly person on coumadin had a line in there hand because the person starting it ran into the same problem you did!!! lack of good veins! No matter where that line will be..it must be watched close those will infiltrate in AC, Forearm, ETC. and wont alarm the pump! Damn i love the ER!
    We usually only do saline flushes. Heparin is most often used for PICC lines. Again, most abx. patients are on CADD pumps, and don't require flushes. If the abx is intermittent, we teach family to do the flushing.

    As for the elderly guy with the cannula in his wrist, he had LOTS of good veins on the forearm, but I kept blowing them. Maybe it was because it was late at night and I was tired, or I was using too high a pressure with the tourniquet. I dunno. But whoever placed that IV was NOT thinking ahead. I'd just like to see some co-ordination between the hospital and community, that's all. It would make everyone's job easier. Some ER nurses know all about CADD pumps, others....well.... A few weeks ago, I sent a pt. to hospital for an IV start. The pump was all set to go, all you needed to do was turn it on. (I sent an Interlink extension tubing with her too!) I showed the patient how to turn the pump on, and she practised doing it to make sure she got it right. ER says: sorry, not comfortable with this! So she had to hang around while the gave it to her by gravity!

    Please, le'ts not take the comments in these replies personally. We just need to vent!
  13. by   missmercy
    Nitwit ideas are for emergencies. You use them when you've got nothing else to try. If they work, they go in the Book. Otherwise you follow the Book, which is largely a collection of nitwit ideas that worked.

    -- Larry Niven / The Mote in God's Eye (1974)


    I LOVE this quote -- as JACHO survey time approaches -- it is especially heart-warming!!

    BTW -- we have a number of chemo patients that have mediport devices implanted for IV access -- these patients love them!! Catheter actually enters venacava and port can last a really long time. No peripheral sticks -- if your ER staff/ floor staff / whoever -- is trained to use them.

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