patient leaving with iv lock in place

[ellencrn]

we are having a number of patients wanting to leave with their IV llocks in place. most are known drug users and they are leaving AMA. i would like to know what is my legal responsibility? can i let them go? am i responsible if they use it illegaly or come back in with a raging infection? most are so belligerent that we let them go and hope for the best. we are a smaller state that is seeing a lot more of this everyday. this is a growing concern to the nurses and would like to know how other places have handled this situation.

thanks

ellen in maine

[flameangel]

rncopper - I was not aware of the correlation between bad teeth and meth - it explains a lot to me, we have a large meth problem in our area. Thanks!

[Nurse Ratched, RN]

I would probably call the police and have the patient explain to the nice officer what he planned on doing with the hep well once he was no longer in the hospital.

[Ahhphoey]

It is our policy that if a pt does decide to leave AMA and refuses to let us d/c the h.l., we first call security. However, if the patient makes it out of the hospital, we send the police to their home and have them brought back to get the h.l. out.

[iliel]

I have to comment about rotten teeth and meth.

As a dental assistant I have seen many drug users who's teeth have been ground down due to coke and meth (constant grinding) this can cause damage to the nerve of the tooth and the pt could need a root canal and grinding can cause chips and cracks. Check it out next time, excessively ground down teeth is a good indicator.

On the other hand, not every meth user has bad teeth. I know of a few who were very anal about cleaning their teeth. It's sometimes more of a socialeconomic situation. If they were exposed to dental care at a young age (under 30) then they are prob gonna have decent teeth if not, then the opposite. You see lots of problems with ppl who smoke drugs, mostly gum disease.

[terrina]

I actually had an MD order, a House supervisor okay a pt leaving with the hep lock in because late scheduled surgery cancelled and reset for early next day. As the RN I questioned and charted but what to do?

[Dave ARNP]

I've ordered heplocks left in. Occasionally we have a cancer patient that we're discharging under pain-managment and home infusion will be visiting them within the next few hours.

What good would it be for NSGing to take the hep out, then for home infusion to come in three hours and then put it right back in?

Also, we have never had an adult patient refuse to have a hep removed. We have, however had one or two leave AMA so quickly that it got missed. Since our heplocks are tagged that they must be removed by the hospital, one of the them actually came back ER and had it removed; the other came into the office the next day and got hers out.

We have also... Had several times that we have let the patient go w/o taking it out. This happens sometimes with kids. If we have a 3yr old who is beside theirself in tears over the whole needle ordeal and mom/dad can't comfort them, I'll usually let them go home with it, and arrange for them to come to the office the next morning. Then, I get them in the office, and with an abundance of tricks and toys can the lock out.

David Adams, ARNP

-ACNP, FNP

[sharann, BSN, RN]

There's a big difference between a patient having a saline lock left in for upcoming cancer treatments and a IV abuser wanting an easier route to get high. I think that it is sick that society has come to this. I would have never thought of someone doing this. I would call the security or police in the drug case. They need to get off, not on.

[hogan4736, BSN, RN]

Pardon me, but call security or police???

Please

We give patients w/ a hx of multiple ODs, a month's supply of psychotrops, then they come to the ER a week later after having taken the whole bottle... Talk about forseeable liability

We try and control patients' lives WAAAAAY too much as nurses!

I agree, we should take it out, but if they skip out, I'm charting it and NOT, I repeat NOT calling the police.

Besides, I worked at a clinic in Phoenix, where many patients left w/ a heplock in to return to get IV ABX in 12-24 hrs.

(Also for peds that may need IV hydration tomorrow)

RELAX everyone...Chart, cover yourself, and leave it be!

[hogan4736, BSN, RN]

Originally posted by sharann

There's a big difference between a patient having a saline lock left in for upcoming cancer treatments and a IV abuser wanting an easier route to get high. I think that it is sick that society has come to this. I would have never thought of someone doing this. I would call the security or police in the drug case. They need to get off, not on.

By that logic, we should round up all the (ex) heroine addicts now on methadone, and the docs that prescribe it should be jailed too... Talk about flaming the fire. No different than letting an IV drug addict leave the hospital/clinic w/ a heplock.

And why do you think some patients need PICCs or Central lines???

BECAUSE THEY ABUSED IV DRUGS!!!!!!!!!!!!!

Should we quarantine them too?