Abdominal IV

[dmurph615]

Recently in our Emergency Department we had a patient going to the ICU who is a frequent flyer, substance abuser, with very difficult veins. Multiple attempts at a peripheral IV were attempted in the hands, forearms, antecubitals, feet, and legs, until we came across a very straight, juicy, superficial vein in the abdomen. The catheter was placed just like in any other site, blood return, easy flush, etc. A supervisor walked by and saw this and now I am getting detailed from my department because she says this is an "inappropriate site" for an IV. When I asked "Why?" She stated because she's never seen one there before. Now my colleagues say they have seen this before, and the ED Physician backed me as well, but I was wondering if anybody else has done this or seen it done? And if there is any literature supporting or opposing this as an appropriate IV site. Any information would be greatly appreciated.

And FYI, the site held up through 2L of Normal Saline and some much needed meds until the patient pulled it out.

[DedHedRN]

Sounds like a fine site to me, but it might have been needed to be placed by a MD. Seems like anything that out of the ordinary should be placed by a MD, just so they can take the blame if need be. I have seen IVs in the feet before.

[sapphire18]

Well...the obvious answer is- get a central line. A pt going to the ICU needs more than 1 IV if you're going with peripherals. Then there's EJ, IO.....

[jadelpn, LPN, EMT-B]

I would use an IO until such time as a central line could be placed, or an MD puts in a EJ.

Because the abdomen is not necessarily a place where movement can be controlled, I would be hesitant--but just because it has never been seen, doesn't mean it has never been done.

After a couple of attempts (and your facility policy should have this guideline) I would put in an IO.

As an experienced IV placer (LOL) anyone who is an IV substance abuser, if able to communicate, can tell you where they shoot up--so I avoid that vein, as it usually will not hold an IV. If they shoot themselves up- the best place to find a vein is in the dominant hand--and if they have someone shoot them up, I will attempt it, but usually go with an IO--as people shoot others up in feet, between toes, their legs.....because unfortunetely, if they can't find a vein and use unusual areas, then in fact it will be near impossible for you to.

My only hesitation with suggesting a central line is that it is more permenent-- then the substance abuser has a new place to shoot drugs.

Sounds like an interesting case. Please let us know what happens.

[gcupid]

LoL! No blood, no foul..... Some people can suck the fun out of anything. i just never thought a manager woukd suck the fun out of saving a life:bored:

[PMFB-RN, RN]

Sure, no big deal and certainly nothing an MD would place. Our MDs don't know how to start IVs anyway. Have also placed them in the chest and those big blue veins in breasts. Foot placement is standard as second choice after arms when not contraindicated.

[NicuGal, MSN, RN]

Back in the day we used those on our big chronic kids that had nothing, if it works in a pinch, sure, but they should be looking at other things such as IO :)

[ckh23, BSN, RN]

If it works than the site is fine. What kind of rationale is "inappropriate site because I have never seen one"? This is why I can't stand most nursing supervisors.

[CodeteamB]

I have never done abdominal IVs because I have never got that far when looking for a site, but we do breasts when necessary (ouch). Basically, if we need access now, any vein that will give blood and take a bolus is fair game. Especially if you had the doc's approval I don't think this is something you should be disciplined for, just part of emergency medicine.

[morte, LPN, LVN]

yup, put a 24 in a superficial upper chest vein once. and you know that vein that goes over the first knuckle of the thumb? if the hands are good size, that'll work...

Sure, no big deal and certainly nothing an MD would place. Our MDs don't know how to start IVs anyway. Have also placed them in the chest and those big blue veins in breasts. Foot placement is standard as second choice after arms when not contraindicated.

[VANurse2010]

I wouldn't call it inappropriate per se, but I'd rather have seen an EJ if I were receiving the patient. They are probably going to put in a central line in the unit anyway...

[Anna Flaxis, BSN, RN]

I would think the risk of complications would be higher in an abdominal site due to the inability to adequately stabilize the catheter, making the abdomen a less desirable site.

In the immediate, life threatening phase of this patient's course of care, I would have opted for IO, then a central line would have been placed by the ED physician prior to transfer to the ICU.

As far as your manager's response, that's a lame rationale. I would check your facility's policies and procedures regarding PIV site selection.