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.
what about anesthesiologists? ours seem to get them in when we cant( in an emergency/urgency , of course...) Granted, that will be one expensive access.
the pt didnt have like EJ access?
Keep in mind I work at a government facility where things aren't exactly the same as private practice, EJ access was sketchy, the doctor and I looked, but the doctor decided against it due to the patient swaying his head back and forth constantly (tweaking), so once we noticed the vein, and the MD didn't oppose, we decided to use it. Obviously this wasn't our first choice, but in the ER, sometimes you have to do what you have to do to help improve the status of the patient. And as far as an anesthesiologist, haha, no way you could have gotten one of those in this facility.
I've put abdominal IVs in before... only once, but yeah... it was way awkward. We needed blood like none other and had to start stat abx, but couldn't do the abx until we got the blood cx's so it was like w/e... I'm going for the one right above the belly button- it was BEGGING to be stuck.
Correct, except IOs are not permitted, and I can't start a central line, so I did what needed to be done to get fluids and meds in, then let the ICU figure it out from there.
The ER MD could have placed a central line. Why can't you do IO's? What is the facilities rationale behind not placing IO lines?
I have actually used the forehead once when I couldn't get anything else. Pt wasn't going to ICU though. The vein was tiny and could only get a 24 guage, but it did the job and lasted until the pt was d/c a couple of days later.
I agree that a central line would have been better, but ER docs I work with will do anything to avoid taking the time to place one and will make us work for hours sometimes to establish a PIV.
Specializes in Emergency Dept. Trauma. Pediatrics.
I love how because they have never seen one before it's not an appropriate place. Sometimes you have to get one where you can get one and if you can get a good gauge and it runs well and works, I don't care where it's at.
Boy, some of you are really making us infusion specialists cringe! I do understand using what you can get in an emergency situation, but please do bear in mind that in a court of law (defending yourself because you infused D50 into an abdominal vein on an adult and it infiltrated, for example), "That was the only vein I could get" will not stand up as a rationale.
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dmurph615
8 Posts
Keep in mind I work at a government facility where things aren't exactly the same as private practice, EJ access was sketchy, the doctor and I looked, but the doctor decided against it due to the patient swaying his head back and forth constantly (tweaking), so once we noticed the vein, and the MD didn't oppose, we decided to use it. Obviously this wasn't our first choice, but in the ER, sometimes you have to do what you have to do to help improve the status of the patient. And as far as an anesthesiologist, haha, no way you could have gotten one of those in this facility.