Do you remove occluded or infiltrated IV right away or wait until new start done?

[Suninmyheart]

I am a new nurse on a cardiac floor and we do our own IV starts. I am curious as to why most nurses keep the old IV in until a new one is placed? I have heard conflicting information on this. In my IV class here at the hospital the instructors said to remove it and not wait until a new one is placed because it doesn't work anyway, and in case of an emergency it could be assumed it is patent by responding staff and just create a delay in treatment. One of my preceptor's (and most nurses I talk to) say it should be kept in but I am not hearing any evidence-based rationales for this.

Of course the goal is to get a new IV stat however this isn't always the case on a hectic floor especially with a hard stick and a wait for the IV team.

I would love your input.

[bigsyis]

First, do what you have been instructed to do by your instructors. There is no rationale for leaving an angiocath in place that isn't patent. You are already thinking for yourself, and that is good. Just because something has "always been done that way" doesn't mean that is the correct way to do it.

[siggie13]

There is absolutely no reason to leave an IV in that is unusable! Your instructor is right and I don't know what the other nurses are thinking. Makes no sense to me!:icon_roll

[Suninmyheart]

...might I add that even my Nursing program taught to leave them in... hmmmmm....

[bill4745, RN]

Take the bad one out first.

[jnrsmommy]

However, check facility P&P. Several places I have worked, the policy is to keep it in place until a new one is placed. Personally, I think those were more directed toward mandatory IV site changes (q 3 days). It makes no sense to me to leave in a bad IV, especially one that has infiltrated and is uncomfortable for the patient.

[siggie13]

Did the school give a reason for leaving them in??? Stuns me

[Tweety, BSN, RN]

Juding from the responses so far, I think your presumption that most of us leave bad IVs in is an incorrect one. :)

I'm with the group that as soon as I find a bad IV, out it comes.

[SICU Queen]

Take it out.

It doesn't work, so why leave it? All that does is open the patient up for potential harm, because it can possibly fool another nurse or MD into thinking that the access is patent and therefore usable...

I'd love to know your preceptor's rationale for leaving it in. If you can find out, post and let us know. :)

[MarySunshine]

I agree with everyone else. BUT a lot of the time when I remove an IV to start a new one it's not because it's infiltrated, it's because it's expired or looking "a little iffy." In those cases, I start the new IV first, THEN pull out the old one.

[CRNA2007]

The reason to keep the old one in until the new one is started so you are not dealing with a bleeding site or bruising/swelling until you have the new IV in place. This is especially important if your next IV is in close approximation to the old one. Once the new one is placed then you can concentrate on pulling the old one and applying pressure to that site.

[suzanne4, RN]

Depends on the location of the IV and what is going on with it. If already infiltrated, then chances are that you are not going to use that extremity again. Would remove it as soon as possible and get warm compresses to the area. If only outdated, then try to get another one in first, before discontinuing the old IV to make sure that you can get one in.

If the site cannot be used because it is no longer patent or is infiltrated, then there is no reason to leave it in; it no longer is a patent site. The reason for leaving one normally is to make sure that you have a good access before removing the old one, but if it is not good, then it makes no difference to leave it in.

From experience, I would get rid of the bad site first, just because the patient is usually fixated on that and it will make it easier for you to place a new line. Two nervous people does not make for a good IV outcome.

If you are placing a new IV just because of the old one expiring, there is no reason to pull that first in case that you cannot get the new one in. In that case, start the new one and then take out the old line.