Every IV in the AC?

  1. 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?
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    About General E. Speaking, RN

    Joined: Apr '02; Posts: 2,574; Likes: 1,619
    ICU nurse (finally); from US
    Specialty: floor to ICU


  3. by   jmgrn65
    yes i see this very often, not only the er but the squads
  4. by   TinyNurse
    Not only is it fast and easy, usually it's a bigger and better vein.
  5. by   NRSKarenRN
    Thankfully, our ER starts low then moves up...

    Personally even my IJ clotted after CAT scan with dye given through it when Renal Colic hit; they couldn't find another site.

    Sometimes ER can't win the IV site game.
  6. by   gitterbug
    I have worked were the AC was used as last resort only. I was grateful and so were the patients. If IV access is that bad then TLC or other IV devices should be considered by physician.
  7. by   rnmi2004
    AC isn't the best spot for long-term use, but try to see it from their point of view. ER is usually a very busy place. Starting in the AC is usually the quickest, surest spot to go; also, certain CTs require the PIV to be in the AC for power contrast injection. The RN may not know what tests will be ordered so why start elsewhere if you're just going to have to restart it for a spiral CT?
  8. by   Daytonite
    i was on an iv team for many years. this is par for the course. the veins in the ac are large and accommodate large bore needles and the iv bolus' the might have to be done, and what all. you are not going to change anyone's mind on this. what we used to do is just change the iv sites as soon as we could get to it. being an iv team that had the luxury of being able to check every single iv site of every patient (very rare, i know), we changed those ac iv sites immediately in order to save them for later use. most floor nurses (and, i'm not knocking you guys because i know you are busy and have other things going on) won't do it, but if the ac veins get infiltrated or phlebitis, the rest of the lower arm is usually no good for any more iv's--usually. you just gotta smile and remember we are all supposed to be working together on a team. taking the opportunity to change these sites is one way i was able to develop and hone my iv insertion skills as a youngun. then, there are those who hope on hope that their iv problems will just disappear and they do nothing. where are you (that's a rhetorical question for each of you reading this)?
  9. by   MomNRN
    I am one of the ER nurses who almost always starts the line in the AC. It is for all reasons you guys quoted above:

    1 - it is easy
    2 - it is fast
    3 - CT would have a stroke and have to restart, if there was anything less than a 20 in the AC
    4 - it is easiest to draw blood off during IV start

    I always look elsewhere, but have to consider why the pt is coming to the ER in the first place. Bleeders, abd pain, and chest pain always get a AC line in my book.
  10. by   vamedic4
    I don't so much have a problem with an IV in the AC as long as it's WELL MAINTAINED and secured well enough so that you don't have to restart it!!! Nothing worse than having a patient come up from the ER with an AC IV and fluid clamped off....duhhhhhhhhhhhhhhhhhhhhh. Or
    Also for criminy sakes put an armboard on the patient if you can...it's bad enough the patient shouldn't bend his arm...but he'll damn sure try...and when he does...your IV is in jeopardy.

    Again..not to bash the ER, it's just part of that "pre transfer" things you need to make sure you do.

    Smilin' in the shade
  11. by   General E. Speaking, RN
    thanks for the feedback. Good points in the posts above, just frustrating for us floor nurses.
  12. by   CarVsTree
    Quote from vamedic4
    Also for criminy sakes put an armboard on the patient if you can...it's bad enough the patient shouldn't bend his arm...but he'll damn sure try...and when he does...your IV is in jeopardy.

    Again..not to bash the ER, it's just part of that "pre transfer" things you need to make sure you do.

    Smilin' in the shade
    Put a pillow under pt's arm. This is usually enough to remind most pts to keep there arm straight. Arm boards are uncomfortable.
  13. by   RN2MSNasap
    This is a great thread for me to reply to as i am now an ER nurse but I was a floor nurse for many years and know the frustration you speak of...I vowed when I went to the ER to try to put the IV access in other sites besides the AC.........Well I did try to keep my vow..but the long and short of it is in the ER the AC is the most rational place for IV insertion... it is easily found and fast.. we draw labs at the same time and even if you started a line in another vein it would take literally forever to draw the bloods off if the return is slow..IE; pts who come in dehydrated or with a low bp...you can place a larger catheter there for ct scan or blood..and the list goes on...I usually instruct the pt to keep the arm straight or I will place an armboard if need be....but look at it this way..the site has to be changed after 3 days.. at least it does where I work...I used to just try to maintain the AC as long as I could and see if i could make it to site change day...
  14. by   neneRN
    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...