stroke patients and IV's

iluvivt, BSN, RN · Feb 6, 2009

Yes this is an acceptable practice...let me see what I can find for you.

PICC ACE · Feb 7, 2009

The issue is in fact diminished blood flow in the arm and the increased risk of thrombosis--remember Virchow's triad? With no movement in the arm,the action of the 'muscle pump' on the blood/valves/vein system is lost. As such,a stroke-affected extremity is a relative contraindication to IV/PICC placement.

http://www.iv-therapy.net/node/396

iluvivt, BSN, RN · Feb 8, 2009

As with anything in nursing and medicine sometimes things are not always that clear cut. Sometimes you have to choose the lesser of two evils or the best choice taking each individuals situation into consideration. If the patient has an AV graft or shunt in one arm and the other arm is affected by a stroke....I will be using the stoke arm. If the patient has a new pacer and really needs a PICC and I have discussed it with the MD...we use the affected side. Sometimes you do not have a choice...you try to keep the risks low. I personally find we have a higher rate of venous thrombosis in our PICC pts when they have edema in that limb pre-insertion.

misswoosie · Apr 27, 2009

The issue is in fact diminished blood flow in the arm and the increased risk of thrombosis--remember Virchow's triad? With no movement in the arm,the action of the 'muscle pump' on the blood/valves/vein system is lost. As such,a stroke-affected extremity is a relative contraindication to IV/PICC placement.
http://www.iv-therapy.net/node/396

But how common are venous thrombosis in upper limbs?

The whole thing about deep vein thrombosis is that the leg is a long way from the heart and gravity is working against venous return form the lower limb.This isn't the case with the arms.

I thought that the reason it was best not to site an IV in the affected arm might be that the patient wasn't "aware" of it and might be more likely to dislodge it or not report if the site was painful.

accessqueen · May 4, 2009

I wouldn't call venous thrombosis in arms "common", but they certainly are not rare. I've seen plenty of patients with multi-vessel occlusions in the upper extremities. re:previous post that said that they noted an increase in clots in edematous arms. I've come to the conclusion that a fair amount of time the edema is because of the thrombus, esp if the edematous arm is bigger than the other. If I'm suspicious, I'll make them doppler the arm to r/o occlusion, and lo and behold, most of the time I'm right.

misswoosie · May 4, 2009

Are we talking about Central lines inserted percutaneously via the arm,or a straightforward peripheral venous cannula?

The OP was asking about IVs,whilst others seem to be concentrating on PICCs and there is a difference to the risk of VT.

I assumed that they were asking about peripheral venous cannulae,rather than central lines.

2 reasons for that

Here in the UK a stroke patient would never have a central line and in other patients we only use jugular or (much less often) subclavian veins for PICC for CVP monitoring,fluid replacement and drug therapy. An anaesthetist may insert a long line pre surgery,but if the patient needs it for any length of time (ie more than 24 hours) it will be replaced with a jugular line.

Not sure about paeds,but the OP was asking about Stroke patients.

accessqueen · May 4, 2009

Yes, I think they were referring to PIV's. I agree with both points of view on this topic. Usu you don't want to use a stroke affected limb, for the previous mentioned reasons. However, in the real world, y ou gotta do what you gottta do. Typically, you end up using the good arm until its worn out, then you have no choice. Understand that repeated multiple IV sticks in any vein will cause scarring, phlebitis and potential thrombus formation. Repeated infusions of caustic meds will cause veins to sclerose and potentiate thrombus.

misswoosie · May 4, 2009

Well maybe we should work on the principle that long term IV therapy in stroke patients is not recommended unless

they are dyspahgic and cannot/won't tolerate nasogastric feeding whcih should be initiated within 24 hours of stroke in patients without a safe swallow.Even then a PEG tube should be considered if it is a long term problem and they are well enough to tolerate a GA.