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 *usually* remove it when I discover it is bad. The exception to this is if I think the site might be saved by someone more skilled than I (AKA IV therapy team). If it's a young un with great veins, I'll just pull. But if this IV took several sticks to get, then I won't pull unless I am 100% certain there is no way the site can be saved.
Not patent? Remove it. Policy on time to change? Wait, start new one, remove old one. Why? If patient is on a drip or otherwise requiring IV site for meds (ie pain or cardiac meds) keep site. That way, if you cannot obtain new site, patient will not miss any doses of medication or will not sit/lie in pain while you either try again or find someone else to try for a site. I have had some patients who have required mulitple "sticks" to regain IV access.
This may just be a difference in my practice area (NICU), but we sometimes leave the catheter in place if we had an infiltration of an irritant and the physician is coming to evaluate for possible Wydase or Regitine treatment.
Since almost all of our infusions involve calcium and/or pressors, we don't use warm compresses, as that vasodilates the area and increases absorption of the irritating substance.
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.
That is what I do most of the time. Of course it depends on the circumstances. I stop the infusion immediately regardless.
It amazes me that there could be more than one opinion on this. If other equipment is out of order what do you do? You remove it for patient safety. Same with IV. The best that can happen is still bad. Get rid of it.
I would remove it because if it is infiltrated or occluded it should not be used, but i would leave something to mark where it was, so you know where to start your new iv, because it should not be started directly below the old one.
Specializes in Cardiac/Telemetry, Hospice, Home Health.
It amazes me that there could be more than one opinion on this. If other equipment is out of order what do you do? You remove it for patient safety. Same with IV. The best that can happen is still bad. Get rid of it.
I think I am with you on this one and I will of course check to see if it is savable first. But my preceptor told me to leave it in so I had to. She said something about it being better then nothing but I did not challenge this because she gets very offended if I present contradicting info or present a challenge.
I think I am with you on this one and I will of course check to see if it is savable first. But my preceptor told me to leave it in so I had to. She said something about it being better then nothing but I did not challenge this because she gets very offended if I present contradicting info or present a challenge.
I'd ask her to explain how an infiltrated or occluded IV is 'better than nothing'.
queenjean
951 Posts
I *usually* remove it when I discover it is bad. The exception to this is if I think the site might be saved by someone more skilled than I (AKA IV therapy team). If it's a young un with great veins, I'll just pull. But if this IV took several sticks to get, then I won't pull unless I am 100% certain there is no way the site can be saved.