IV'S

[TKOLRN, BSN, RN]

One of our staff has raised the issue that every patient in the ER should have IV access (ie. Hep. Lock) if they are going to have labs drawn. I am against this idea for many reasons. Any thoughts/ideas re. what your dept. currently does.

We also have many MD's that order IV's on everyone, only to have them d/c'd a short while later with minimal infusion. My persistence has now gotten all their TKVO lines to hep. locks at least.

Looking forward to your feedback.

Ted

[Miss Mollie]

Ted,

to be honest, I think putting an IV in when you draw labs and keeping it a saline lock, or hep lock whatever you guys use, is a good idea. Our ED does do that. We find the pt likes getting only one stick- especially if they have bad veins. I don't see any point in KVO fluids- a well flushed lock will stay for hours. But, if you are going to stick them, why not put the IV in and then DC it if not needed. I realize there is an extra expense involved which is bad, but it is nice when you get a critical value you weren't expecting to be able to just start the meds. AN interesting topic, I never thought much about it, one stick or two- but now that I am thinking I can see some economic things as well as the danger of sending someone home with one in ( has been done by a known drug user, eeek) etc. Thanks for the interesting idea.

[hollykate]

bbqchick,

I'm not sure exactly what you mean by the questions above me!

First of all an access that does not flush can't be considered access. You can try to back up the catheter a little to see if it will work that way... In the ED I used to work in, the nurses get the blood- so if they can't get blood from an IV they either have to do another IV, or if it flushes ok, stick for labs. Great veins that play a disappearing trick will do the same to a needle with no catheter on it. Most pts I have had get pretty hot under the collar if you stick for blood then 30 minutes later turn around and say now I am going to stick another needle in you to give you fluids. So I am all for sticking a catheter in if Labs are to be obtained. As Miss Mollie mentioned there is a monetary factor involved there, but also a pt satisfaction factor. One of the biggest complaints I hear is about the nurse who stuck me 6 times- then I find the RN had to get blood cultures, and serial CKMB and troponins- she had very little choice!

[longforseaair]

What has happened when someone has great veins that disappear as soon as you start to stick?

And...What has happened when you get a flash and advance the catheter, remove the needle, etc. and the access won't flush?