In researching longer iV Cath's for peripheral guided IV startes, a response I got here, made me review my policy. Although I had adaquatly covered credentialing and everything I don't think I have the possible consiquences and things to watch for covered. This policy is to cover MD's as well as RN. My specific concern is the use of deep brachials. RN's aren't allowed to attempt them but the MD's are. My policy prohibits using this line for contract for CT angio's due to the high risk of extravisation.
Does anyone else have a policy they can share or have other risk area's that I need to include?
What we need to realize here is that brachial vein is near the brachial plexus and if you have an infiltrate and especially an extravasation in this area the patient can have a permanent disability and a permanent nerve injury. The catheters placed in these deep veins are inserted at a deeper angle and they are subject to much more motion and movement than a traditional PIV site Most IV experts have realized that these US guided PIVS are not always the answer to gaining access on a patient with limited veins.....They do have a much higher incidence of infiltration,extravastion, leaking and diminished dwell times. I would much rather use my bag of tricks and get a good IV site in the traditional way... than one that will infiltrate the next day. These infiltrations b/c they are deeper are much more difficult to detect..so by the time you see them the damage may already be done!!!! Also it is important to note that most extravastion injuries can not be fully evaluated for 1-2 weeks after the actual occurrence...you may not always to be able to tell right away the extent of the injury!!! We absolutely do not allow MDs or Rns to place in the brachial veins for routine IV therapy..rather we use the cephalic and the basilic vein,just above the ACF or access below the ACF. So you are NOT limiting yourself you are providing safe and prudent nursing care. When a midline is in place it as restrictions on the medications and IV fluids you can infuse...so you can ONLY infuse isotonic or near isotonic infusates and those with a ph between 6 and 9....WELL a PIV in in the brachial vein will have its tip in the same location as the midline. That is something to think abut
Last edit by iluvivt on Mar 8, '10