IV in AC

  1. 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 arms. I know it is easier for paramedics to start them there, but I'm not sure the reason for ER to start them there. Perhaps someone can enlighten me?
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  2. 50 Comments

  3. by   meownsmile
    I agree, i hate those AC sites. ER is only intrested in the easiest place for them to get a site and administer pain meds or whatever they need to, and thats ok, thats their job. Their concern is not for the longer term comfort of the patient if they end up being admitted, it becomes our problem then. We usually leave them in until they are wasted, pull them and restart. We dont restart a new site just because it is in a awkward place unless there is reason for it to be. They usually dont last that long in the AC anyway after the patient reaches the floor.
  4. by   SouthernLPN2RN
    Ya know, I've always felt the same way. I hate AC IV's. When I transferred to an office, I had to learn to draw blood, with the preferred site being AC. I have never and will never put an IV in the AC as long as I have a choice. I don't even like drawing from there. I feel that it's harder to stick an AC than more distal sites. Just my $0.02.
  5. by   ?burntout
    I don't like AC IVs either. We do tell the patient we will change it if needed. I use the AC for a last resort on an IV-I try to find other distal veins first.
  6. by   psychomachia
    Quote from webbiedebbie
    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 arms. I know it is easier for paramedics to start them there, but I'm not sure the reason for ER to start them there. Perhaps someone can enlighten me?
    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.
  7. by   suzanne4
    I have worked OR, as well as a Level I Trauma Center, and I much prefer getting a patient with a #18G antecub., than a #22 or #24 in the hand when they are going to be going to the OR for a possible ectopic. You want the quickest way to get fluids in............and personally I prefer getting my blood taken from A/C area rather than from my hand because of bruising and pain.
  8. by   Dixielee
    Most of our ambulance patients come in with an existing IV. When a patient comes into the ER complaining of chest pain, abdominal pain, syncope, vomiting blood, etc. we have no idea at the onset what to expect from that patient. We have to assess, start and IV, draw the labs, etc in a few short minutes. If we suspect the patient may need blood, they need a large bore IV. If we suspect they may need a CAT scan expecially for PE protocol, they need at least an 18 ga in the AC or x-ray will not do the scan. If it is a cardiac patient who may need cath or thrombolitics, we want the largest and easier port available, usually 2 sites. If the patient is unstable and we need to give large volumes of fluids rapidly, we need a large bore IV. If the patient is in SVT, and we need to give adenosine, we need an IV as close to the heart as possible because the med has a short halflife. As stated above, many patients request it in the AC. If a patient comes in with a simple headache or something that will probably not be admitted, then it doesn't matter where the IV is because it will probably be short term. Unfortunately, ER nurses do not come equiped with a crystal ball and a star trek style tricorder, so we must just do the best we can in a short period of time. So try to cut us a little slack and try to walk a mile in our shoes. How many patients do you care for in a 12 hour shift on the floor? 4?, 6?, 8? Remember in the ER with our turnover rate, each nurse may see 20 or more patients in a shift and have to assess, treat and dispose of each one. Volume also has a lot to do with what we do. We do not have the time to buff and fluff patients. The priority is to stabalize, treat and either discharge or transfer while of course keeping the family apraised of the ongoing situation, providing blankets and coffee for visitors, keeping drunks in the bed...........
    Last edit by Dixielee on Jun 14, '04
  9. by   Hellllllo Nurse
    The ER nurses gotta do what they gotta do, and floor nurses gotta do what they gotta do.

    Personally, I never heard of this business of nurses being "off the floor" when ER wanted to report on an admit.
    The enire time I worked med-surg, I never got one, single lunch break. That's one of the reasons I won't work there anymore.
  10. by   canoehead
    Hey, if you and the patient prefer another site, go ahead and move it. If the AC works for the ER best that's where they put it. General rule- you put it in, you get to pick!
  11. by   teeituptom
    Im an ER nurse of long standing and the AC isnt my first choice.
    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.
  12. by   traumaRUs
    ER RN here too - I use the AC because it is easy to access and as another poster put it - we don't always know what is going on with the patient at the beginning. Does that help?
  13. by   Tweety
    Webbiedebbie, I would say that Dixielee enlightened you pretty well.
  14. by   webbiedebbie
    I would say so! The only thing I got out of it is that it is "easier" to start one there and it seems to be easiest access. (Understand this is why EMS uses this site). I was taught to begin at the lower site (hand, wrist, forarm). AC is the last place we use if unable to obtain in other areas.

    Everytime the patient bends their arm, it cuts off the IV. AND, I have been told that it is painful in the elbow by patients. IV's hurt no matter where you put them! Not to mention the fact that it hurts them again because I have to restick them. I'm a busy nurse too, so I don't buy that reason...not to mention the added cost to the patient and increased risk for infection. I will accept the cardiac reason for medications, though.

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