Every IV in the AC?

Specialties Med-Surg

Published

I had to restart many IVs this weekend. Almost all our patients coming from the ER have an IV or SL in their AC. I realize this is an easy/fast place to obtain access and I am NOT bashing ER nurses. It seems to me that almost all of these IVs need to be restarted due to leaking, clotting off, accidently pulled out or the IVFs are positional. When the ER is rocking and rolling and they are getting slammed or it is an emergency situation, I can understand. But, every person- young, old, fat or thin has an AC IV? It seems the patient ends up paying the price because they end up having to be restuck. Many of these people have lots of other healthy vein sites.

Wondering if anyone else has the same issues?

Specializes in Emergency, Trauma.

Just have to echo what the other ER nurses are saying...we look at any ER pt as having the potential to crash until the diagnostics come back and we can see what's going on with the pt. I want a big line in a big vein that I can push code drugs through, pour in fluids, run pressors and other caustic meds into, give blood through (sometimes with a rapid infuser that pumps a liter of fluid or a unit of blood over 2 min). CT wants an 18 in the AC for chest scans. I want to draw my labs and put in my line at the same time without hemolyzing my specs, and then be able to use the line for repeat labs/serial trops, etc. If EMS has already started a line (usually in the AC), then I'm not going to stick the pt again; I'm going to switch that line to a SL and use it. Our hospital wants EMS lines out after 24 hours, but they're generally in the ER less than that, so we don't pull them out, we use them.

I understand the issues for the nurses upstairs, but please understand that ER nurses aren't doing this to be spiteful or because we don't know any better; there really are reasons for what we do...

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All the above posts have excellent explanations. Usually I find the ER nurses to have found access in places I wouldn't have thought to attempt.

Also, remember that some of those AC sticks might have happened in the field, and most hospitals have policy requiring them to be changed out within 8 hours.

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Specializes in ER, ICU, Infusion, peds, informatics.

i try to think of the floor nurses when i start ivs (really, i do :wink2: ). and i don't start most of my ivs in the ac, except for two types of patients.

1. those who are unstable, and require fast access

2. those that i don't think will end up getting admitted. for most, ac hurts less, and since it is so big, it blows a whole lot less. it can be difficult to tell, though, just from the initial presentation if a patient will be admitted or not.

for the patients that don't need "urgent" iv access, and their presentation makes me think that they may get admitted, i try to go lower than the ac. that being said, i do admit that if i can't find a non-ac site in a "reasonable" amount of time, i go for the ac anyway. sorry.

keep in mind, too, that for the dehydrated n/v/d patients, we may have to start the iv in the ac because they are too dehydrated for anything else. but after a few liters of fluid, they may be hydrated enough for a different site to be used.

interestingly, most of our ems ivs are done in the hand.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

I have talked to my hubby (paramedic) many times about this and says the same things as the above posters. Many times you can't find another site till hydrated, need quick and large bore sites immediately, and heck...in a 15 minutes transfer code three (lights/sirens) IV must be done quickly so you can do your assessment and handle anything that comes your way! 15 minutes isn't long!

But hubby will try really hard (if time allows) to put it into a lower spot to help out! He has been a paramedic for 13 some odd years and knows it is helpful to gain that access for longer term IV's if needed. He also trains others to do this too...and I think it is a very nice courtesy to pt and staff!

Our ER will typically (again if time allows) keep the AC line saline sealed, and start another. That way if something needs to go in fast and big...they still have the AC...but if not...then we have another to use and we can d/c the ac one PRN. That is really nice! (especially if for some reason we have to give blood and the AC has a larger bore in it!...better than a re-stick with a big bore!

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Another thing to consider, who placing the IV/heplock?

In my experience, many times the ER tech, not the nurse will place the site. Often they want to be assured of a "sure" thing and not feel like other's are judging their skill if they don't get a site. I was the night nurse in the ER for 5 years and then moved to Med Surg as a mangaer so I've seen both sides of the coin. We resolved this by talking with the ER manager who passed it along to her techs and it got better. There are always obvious reasons why the site went into the AC in the first place, but if the tech understands you really need to save that spot for a true emergent situation, and that its not a critique of their skill, their much more likely to leave the AC alone. Besides, how will you ever get better if you always go for the easy one?

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