Can you guys help me with this?

[SillyStudent, ASN, RN]

I am a new nurse, and got a job in a critical care envorinment. I was taking care of a patient who had a CVA and was flaccid on the rt side. She had 2 IV's at the beginning of my shift. The one in the left arm (locked) began to hurt her when we flushed it and my preceptor told me to remove it.

The one on the right flushed great, no blood return (22g). I gave her lopressor through it at 1800, and she had conscious sedation through it at 1500. She had 60 ml/hr flowing through all day.

Now, this lady had generalized edema. About 3+...she was soft and puffy.

When the next shift came in, the nurse, (after picking everything I did all day, which totally made me sad because I didn't pee for 12 hours and thought I gave her great care. ) d/c'd the IV and said it was infiltrated. The nurse made the statement, "hard as a rock". I went back in the room and examined her, and found no hard flesh, just puffy soft flesh consistent with the rest of her. I said, this doesn't feel hard to me, it feels like the rest of her. The nurse said that "I know when an IV goes bad".

So, how did this person know the IV was bad if it flushed so well and all of her meds seemed to work? The lopressor worked, the sedation worked, and the site was not hard 15 mins after it was dc'd. Could it have gotten soft in 15 minutes? I am confused, as I assessed this site literally 5 minutes before I gave report and found nothing wrong. Also...this poor lady's veins are so bad that IV therapy was unable to place a picc line under US at the bedside. I didn't want her to be stuck another 5 times for a site.

Help a new nurse out!

[12-lead/12-hours]

Since no one was actually there to assess the site with the oncoming nurse just before the second catheter was removed, it will always be your word against hers. The bigger issue is, what are you going to do for access in an ICU. If a PICC could not be placed under floro, had anyone given thought to a central line into her IJ or SC areas, or were these areas attempted as well without success. Let's hope that the managing team is talking to the Radiologists, on how to ensure access for her.

12-lead/12-hours:D

[SillyStudent, ASN, RN]

Since no one was actually there to assess the site with the oncoming nurse just before the second catheter was removed, it will always be your word against hers. The bigger issue is, what are you going to do for access in an ICU. If a PICC could not be placed under floro, had anyone given thought to a central line into her IJ or SC areas, or were these areas attempted as well without success. Let's hope that the managing team is talking to the Radiologists, on how to ensure access for her.

12-lead/12-hours:D

I didn't care if the other nurse was right .....I just want to make sure I do not leave an infiltrated IV in a patient. I am new and still a bit stupid.

And you are right, the big issue is...how to get access. I suggested a subclavian or IJ to the resident when we couldn't place the PICC, he wanted to wait. BLAH!

[Madam PICC]

There are a few problems going on withthis patient. First the patient had a CVA with affected R sided weakeness. The IV should not have been placed in the R arm because of lymphedema complications. Second if the patient was having generalized edema the infiltration can be hard to visualize. The infiltration would not go away in a short time because the patient already had fluid issues, if that was the case the patient would not have edema. A way to check if a patient has an infiltration is to check for blood return, it doesn't have to be a great blood return because it is a peripheral IV, but if the bag of IV fluids is held dependently there should be some blood back flash.

In reguards to not getting a PICC line there should be some talk about some type of CVC because the patient has minimum access and should not have to be treated like a pin cushion.

As a student or new grad an option to assist you in your learning process; a good idea is to spend a day in IV therapy, especially if you have an RN IV therapy staff they can be a world of information. Good luck to you in your learning process. Another avenue is to look up infiltrations, extravasations, insertion of IV guidelines, and IV care on the internet to help you find info. Also google images to see infiltrations, and extravasations to see pictures of them to appreciate good IV care.