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.
The only time I do not remove a bad IV is when the pt is being thrombolized. I cap it off, put a 2x2 and tape over the cap so it's not accessible, and write on it "NO" or "BAD".
In all other pts, the infiltrated/clotted line comes out first. No sense leaving it in if it's not patent.
Can't see any rationale for leaving it in and doing so might potentially increase the risk of infection or fibrin being forcefully flushed through by an unsuspecting nurse-out they come where I'm concerned!
If it is infiltrated you can't push anything through it anyway (or shouldn't even if you could actually "force" something in). Take it out and get a new site.
For our wee ones, I've seen an infiltrate of an ankle IV eat away almost an entire calf, so I pull sooner rather than later. I'd rather have to start a new one than see that happen again. The only exception is an ECMO pt, where pulling ANYTHING is a no-no. Then, as said above, I cap it and tape over the port so it can't be used.
For our wee ones, I've seen an infiltrate of an ankle IV eat away almost an entire calf, so I pull sooner rather than later. I'd rather have to start a new one than see that happen again. The only exception is an ECMO pt, where pulling ANYTHING is a no-no. Then, as said above, I cap it and tape over the port so it can't be used.
I saw something similar to what Eliza Bells mentioned...
I'm not a nurse yet, but on a peds floor that I work on there was a babe recently that had most of the fingers on one hand and part of the hand itself amputated after a bad IV infiltration. I don't know how long the IV was in place after it infiltrated, but after seeing that I think that once I become a nurse I would pull the bad IV immediately.
I don't know how long the awful cratery one was in, but I do know of one that caused a nasty burn/blister in under an hour. I know because the day nurse and I checked it together during report, and when she did her first round of cares at 0815 it had gone bad. Of course we both felt like it was our fault, not the other's!
To be honest, I never thought too much about the process; leave in while starting a new one. So I voted leave in. I suppose, the reason is because I have to go back to the supply room to gather appropriate supplies (including gauze and tape, needed to take out the old one). My first priority is to establish a new line, and resume my infusion.
If it is still viable leave it alone until replacement sited, but if it is definitely occluded it is best to remove it to prevent complications. Your mentor may not have explained her rationale for leaving it in-situ, but go with what will cause the least harm to your patient.
TazziRN, RN
6,487 Posts
The only time I do not remove a bad IV is when the pt is being thrombolized. I cap it off, put a 2x2 and tape over the cap so it's not accessible, and write on it "NO" or "BAD".
In all other pts, the infiltrated/clotted line comes out first. No sense leaving it in if it's not patent.