comments about patient's w/ IV's?

limabean · May 17, 2006

It is a standing order at my hospital for a patient to get at least an INT. We dont start one only if the doctor says not to....as in your situation. The reason is b/c you need to have an access in case of an emergency situation. I think if the patient is sick enough to be admitted then they need an IV. You dont want to have to start an IV in the middle of a code if you dont have to. However, if they are just there for a short time and the doc says no IV needed then I wouldn't start one. Also with your pt he was a dialysis patient so I'm sure he had an access that could be used in an emergency situation. I'm sure policy is different everywhere.

McGyverRN · May 18, 2006

Does your pt have a permacath for easy IV access if needed, or an AV fistula? In my hospital, if they need a heart monitor (either on a tele unit or a remote tele), they must have an IV site. An order for tele, is an automatic order for an IV site.

rnmi2004 · May 21, 2006

I'd rather be stuck before an emergency situation occurs. The fact that this dialysis pt is on telemetry implies to me that he is at a greater risk of a cardiac event occuring than your average hospitalized patient (whether it is due to a cardiac hx or screwy lytes, being a dialysis pt). I'd be nervous about him not having access and I would document that I requested an order for IV access & the MD would not grant it. Does your hospital have standing orders regarding automatic IV access in a situation like this?

Long Term Care Columnist / Guide · May 21, 2006

My hospital had standing orders for a saline lock to be placed whenever a patient went on telemetry. It's a good precaution---I was glad to have one when I was in last year for chest pain, just in case something went terribly awry---and it's no big deal in most cases to throw in a SL when you admit a tele patient. In fact, we had a number of frequent-flyer renal patients who'd come in on tele, and I don't recall an MD ever saying not to start the SL (not in the same limb as the dialysis access, of course). Weird.

elthia · May 21, 2006

I'm a hard stick( last timetook 7 sticks by 3 different nurses for IV access), but I'd rather have IV access put in when it is nonemergent and the nurses have time to look and get someone more proficient to start the IV, than end up with a femoral line put in emergently at the bedside. However DH says he has no prob signing consent for me to get a central line if I were unconscious.:uhoh21:

Where I work it's on the standard order sheet, if they are telemetry they have a saline lock. What drives me crazy is when the MD insists on a 16 or 18 guage... a 22 is sufficient for most needs, including a large volume bolus and blood transfusion.

meownsmile, BSN, RN · May 25, 2006

I may be mistaken but in most acute care facilities a patient may not even meet medicare/medicaide criteria for the stay if they arent recieving IV antibiotics, pain medication or fluids. Unless they can otherwise show they are monitoring the patients ability to hydrate PO. It just seems to be i hear quite a bit from our SS/discharge planning if they arent getting something IV they dont meet criteria.

ljds · May 28, 2006

Our protocol is that if they are on tele, they must have IV access. So yes, we put a saline lock in everyone on tele who comes in.

allnurses Guide · May 28, 2006

I'm confused as to where you are? Do you work in a hospital or in a dialysis clinic, currently???

perfectbluebuildings, BSN, RN · Jun 17, 2006

What about with peds patients... most all of our peds patients do get IVs but several do not, especially asthma or croup, or a few of the "chronic" kids who are really hard sticks and not expected to need anything IV? I never knew about the insurance/medicaid not paying if pt has no IV, that's interesting. Also not to hijack the thread but I have an IV question... in peds we keep a PIV until it stops working, but I've heard that's different in adults, that you have to change sites every so many days/hours? Just curious. thanks for listening! :)

allnurses Guide · Jun 18, 2006

What about with peds patients... most all of our peds patients do get IVs but several do not, especially asthma or croup, or a few of the "chronic" kids who are really hard sticks and not expected to need anything IV? I never knew about the insurance/medicaid not paying if pt has no IV, that's interesting. Also not to hijack the thread but I have an IV question... in peds we keep a PIV until it stops working, but I've heard that's different in adults, that you have to change sites every so many days/hours? Just curious. thanks for listening! :)

In my hospital we are supposed to change IV sites in adults every four days. The vast majority of our peds patients are not here that long.

Also, interesting that you do not put IV's in pediatric respiratory patients. We have a peds doctor who insists on IV's in *all* of his patients. One night I had a little boy who we could NOT get an IV in, after many tries, and I had to call this doctor. He was insistent that the little boy had to have an IV (the boy was in here for something respiratory). I told him that later on in the shift there was a nurse coming in who was an EXCEPTIONAL stick, who would possibly be able to get the IV in. He made the comment "Well that will be fine, as long as the patient doesn't CODE by then".

Is he right? Is or isn't an IV necessary in the case of *respiratory* failure? Or was the doctor thinking that if the child goes into respiratory failure, it could eventually lead to cardiac arrest, in which IV meds would then be necessary?

perfectbluebuildings, BSN, RN · Jun 18, 2006

The vast majority of our kids, do get IVs. The ones who most often don't are "croupers" who the doctors think will just be there to need some more breathing tx- the "happy wheezers" if you know what I mean. Or if they're there for RSV and just needing very frequent suctioning for a night or so and we wouldn't ever be using an IV. Almost all our patients DO need one for hydration or IV antibiotics or some other IV med. But if not, they won't have one unless they start not eating or whatever. (Keep in mind, that this is just my hospital, and probably varies alot among peds hospitals...)