sickle cell pt..

  1. hey evryone so i treated a sickle cell pt last night... this pt had no vein anywhere in the world... everything was sclerosed and scarred... pt had a long history of iv drug use... the er couldnt even get a line in so they put a hep lock in the internal jugular... question is can i use this line to draw labs from?... reason i ask is i was told by the outgoing nurse to just draw his labs through that line.. i tried but there was no blood return... and i couldnt fund a vein anywhere... how would u deal with this type of pt... i ended up endorsing to the next shift and forwarned them that it would be most likely that theyll need to find a resident to do a femoral draw or put in a line... i hate endorsing my labs to the next shift... do u think this is ok?
    •  
  2. 12 Comments

  3. by   GatorRN
    Doesn't sound like you had much choice but to pass it on. You'll run into this from time to time all you can do is try your best to find a site. I'm assuming you asked another nurse to try as well. Sometimes someone from the lab can find a site, or ask if someone from your ICU can come give it a shot. A girl I used to work with in ICU was the best in the hospital, she'd start a site in the foot if she had to, she was always being called to other floors for hard sticks. Sounds like this pt needs a central line.
  4. by   traumaRUs
    Feet??? That and ankles were my favorite places to go. Another place you can draw labs is from varicose veins - not pretty, but ti gets the job done.
  5. by   crb613
    Ok at the risk of sounding stupid....the feet? We are not permitted to start anything in lower extermities. Is this the same at most places? and do you call the doc & get an order to be able to stick there? Thanks & yes I am new.
  6. by   meownsmile
    Yep,, i vote central line. We have had several that we HAVE to put central lines in for. Otherwise there wont be any labs, pain meds nothing. They have no veins left.
  7. by   RazorbackRN
    Quote from crb613
    Ok at the risk of sounding stupid....the feet? We are not permitted to start anything in lower extermities. Is this the same at most places? and do you call the doc & get an order to be able to stick there? Thanks & yes I am new.
    I work in a burn unit, so veins are few and far between for many of our pt's as well. Usually until a doc gets there to do a CVL, we hit whatever spot we can find. The ankles and feet are my favorite because usually the veins are big enough to tolerate the volume we have to give.

    I've never heard of a hospital that doesn't allow lower ext. IV's, as sometimes that's all that is available.
  8. by   miko014
    I work in a large hospital (just found out the exact number yesterday...1059 beds), and, on our unit at least, we have to get an order to use feet/lower extremities for any kind of stick. Not to say that we never do it, but we have to have an order for it. I don't know the reasoning behind that (probably something really simple that I just never thought about), but I do know that it hurts like...well, you know...to stick feet.
  9. by   ChocoholicRN
    During training at my hospital, we were told that we are never to use lower extremities for any kind of stick, it's just not permitted. And being that I work on an oncology floor, a lot of my patients have bad veins so I've gotten pretty good at finding the few good ones. Definately check out the ICU nurses. One of the head nurses on my floor is the best IV nurse in the whole hospital, but also try the lab, this is their specialty (drawing blood, not IV's)
  10. by   GatorRN
    Quote from crb613
    Ok at the risk of sounding stupid....the feet? We are not permitted to start anything in lower extermities. Is this the same at most places? and do you call the doc & get an order to be able to stick there? Thanks & yes I am new.

    Yup, the feet are great places to find a site when you have nothing else. I'm not sure if it's the same at most places or not. As far as an order, no, never called beforehand. But then, I've always worked in ICU, where we've done a lot of things without an order, and the docs would cover us with an order after the fact. When it comes to a life or death situation, you do what you have to do.
  11. by   traumaRUs
    Feet are fine as long as the pt isn't diabetic and has feet - lol! Also, an external jugular vein works well. In our ER, we had to do 10 under supervision of an MD but then you were on your own. Its not a central line even though it is in the neck. You just gotta know the anatomy.
  12. by   AfloydRN
    Ej's are great. Large veins, easy to find even on SCC patients. Most SCC patients will not allow feet sticks, but you can always ask. What about the " Drunk Driver" vein on the back of the arm? That is usually a favorite of mine that most don't choose so it's not sclerosed.
  13. by   nursejohio
    We aren't allowed to use anything on the lower extremities. IV therapy says it's because the results would be worse if the line infiltrates.
  14. by   timdmb
    so it came down to a resident doing a femoral stick, just a little update... pt ended up being dc very quickly, as was expected pt show up to various hospitals says hes in crisis... tough thing to turn away obviously, thanks for the posts and i asked about the lower extremity sticks and its in our policy and procedure the only one to stick on the lower extremity is our residents or attendings... "drunk driver vein was completely sclerosed its amazing... usually i just ask the pt if theyre users where i can go... this pt however told me up front i wont find anything... and actually asked me to go to his neck..... riiiiiight... anyways im just babbling on thanks for all the responses...

close