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.
Just as an aside, "the doctor said it was okay" is never a defensible rationale. You are responsible for your actions as an RN. If you know something is unsafe, you have an obligation to advocate for safe practice.
Rationale? You really want a rationale for why a peripheral line is safer than a central line? It's a more invasive procedure, higher risk of infection, etc.. And obviously the doctor saying it's okay isn't what I needed to start the line, but research articles and word of mouth from experienced clinicians is enough. The patient didn't receive phenergan or any other dangerous medication. He needed FLUIDS! And he got them in a safe and effective manner.
Rationale? You really want a rationale for why a peripheral line is safer than a central line?
Wow.
At any rate, the fact is that whether a central line or a PIV is indicated is contextual. It is not a black and white "one is always safer" than the other kind of thing. Studies on infection rates r/t PIVs are scant if even existent, and infection rates r/t central lines can be very low if proper protocols are followed.
Specializes in Infusion Nursing, Home Health Infusion.
What is INS' position regarding the placement of peripheral IVs on a patient's torso, i.e. patient's upper chest? Thank you! A: Veins in chest/shoulder areas are considered collateral vasculature and should not be used. The blood flow in these vessels is not sufficient to dilute medications, and therefore can result in phlebitis, infiltration or extravasation.
That is what they have to say about it! Have I seen it? oh yes I have. So what should you do when you take over care of this patient? Immediately obtain another more suitable access. Often times after a little hydration one can be more easily seen. I never trust anothers assessment. I cannot tell you how many times I have been told that I will not get an access and I walk right in and get it. I know my skill level andIam not deterred by those comments.
So get someone there to get the job done and advocate for your patient. That may be a central line of some type or a better peripheral site . If the site was used during an emergency once the patient is stable get another more suitable access.
This reminds me a recent case I was called for. The patient had received 2 to 3 days of Vancomycin in her right breast and I found how she had a functioning implanted venous port that was only 9 mos old. The sad part is that I see this way too many times or some version of it. A good assesment needs to be done as well.
The IV nurses posting are absolutely 100 percent correct. You need to protect your patient and provide nursing care to at least the standard of care in this situation. In a court of law you would be held to that standard.. They would take their lead from INS and other experts in the field and you would be considered negligent if they proved harm. Also do what is prudent to protect your ability to earn a n income.
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.
I disagree. If the patient has a sugar of 20, and is unresponsive, you get what you can get, and save their life. You're watching as the infusion goes in, so there would be minimal damage if the vein blows. Once the patient has decent circulation you can get a better site. If the doc is in another room, and time is critical, do what's necessary to keep your patient alive.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Just to bring to mind......SUbQ infusions are still being used.
We used to do subq infusions for dehydration all the time in pre-historic times.
Hypodermoclysis........it's very effective and a perfectly appropriate alternative when venous access is no longer viable. This route can also accommodate up to 3 liters of fluid/day, 2 separate sites. The needle is anchored under the skin, which mostly comprises adipose tissue, rich in blood vessels, enabling absorption.
Hypodermoclysis, the subcutaneous infusion of fluids, is a useful and easy hydration technique suitable for mildly to moderately dehydrated adult patients, especially the elderly. The method is considered safe and does not pose any serious complications. The most frequent adverse effect is mild subcutaneous edema that can be treated by local massage or systemic diuretics. Approximately 3 L can be given in a 24-hour period at two separate sites.
Common infusion sites are the chest, abdomen, thighs and upper arms. The preferred solution is normal saline, but other solutions, such as half-normal saline, glucose with saline or 5 percent glucose, can also be used. Potassium chloride can be added to the solution bag if needed. Hyaluronidase can also be added to enhance fluid absorption. Hypodermoclysis can be administered at home by family members or a nurse; the technique should be familiar to every family physician.
Hypodermoclysis is a method of infusing fluid into subcutaneous tissue that requires only minimal equipment. Technically, it is easier to administer fluids subcutaneously than intravenously. During the past two decades, many articles advocating this method have been published in the geriatric and palliative medical literature. However, hypodermoclysis is suitable for use in many hospital and home-care situations regardless of the patient's age.
While care has to be taken to avoid caustic meds and use this site judiciously ......an infiltrated IV in the abdomen is subq infusion of IVF.....which is used for IV hydration as an acceptable standard of care. So the temporary used of the vein in the abdomen in absence of other alternatives is acceptable practice for not all of us are CRNA's like ruler of kolob and can just pop in an EJ IV.
Specializes in Infusion Nursing, Home Health Infusion.
Sure there are many medications I have given this way especially in homecare. The medication and/or IV fluids still must have that listed as an acceptable route of administration. In addition ,what I see all the time is that as long as the patient has an IV access it is used for anything and everything. This is why I only place midlines in very specific circumstances that I can guarantee that it will only be used for what it has been placed for. So if someone comes along and administers some Calcium Chloride through that and it extravasates that would not be considered hypodermoclysis. Also the IVF were not started out that way so if it did infiltrate or extravasate it would then be considered a complication of IV therapy and not ok well now the patient is receiving hypodermoclysis.
Its a bad idea and if it must be done to save a life......OK I get it.... but as soon as possible change it to a site that meets the patients needs.
OCRN3
388 Posts
What would happen of the iv infiltrated in the abdominal iv? Just curious because I would think it would be the same as in a AC site no?
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