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 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.
Same here.
To me, as long as the patient has no complaint, the goal is to get something patent immediately. I can always pull the bad one later if I'm pressed for time.
Or, at my facility, we always have Techs who are hungering for the chance to DC an old IV, so sometimes I'll get the new IV and delegate the removal of the old one.
An infiltrated IV is a whole 'nother problem and I deal with that first, if it happens.
Specializes in Medical and general practice now LTC.
remove it, if an emergency arises you need a new one. No good giving drugs through an access that doesn't work, drugs infiltrating may cause a lot more problems. Sometimes we find in the UK access was put in and not always a necessary thing so decisions was made individually to whether insert or not. Things change and access can be inserted if required
Specializes in SICU, EMS, Home Health, School Nursing.
Sometimes if we have an IV infiltrate while giving a certain medication (dopamine, etc), we have to leave the IV in so that we can give a medication to help stop the damage caused by the drug. If it was just a maintenance IV, I will generally d/c it before starting a new one. If the IV just won't flush, I will play with it a little bit before removing it because sometimes if you tear down the dressing and readjust the IV it will work. Sometimes the tip of the catheter gets up against the wall of a vein or it gets a little bit kinked and if you move it slightly while flushing, it will become patent again.
Please explain what ECMO means? Today is the first time I have seen that. Thanks.
ECMO stands for Extracorporeal Membrane Oxygenation. It's similar to the cardio-pulmonary bypass used during open-heart surgery. In babies it's used to let the lungs or heart rest and heal after respiratory or cardiac failure. The reason you can't pull an IV is that the patient is heavily heparinized (to avoid thrombus formation in the circuit), so they will bleed and bleed badly. No IV starts, no fingersticks for blood sugars or other labs, and at least at my institution, if you lose your Foley, too bad. You leave it out.
I pull out the old before starting a new one. But... if it is only painful because of the psychological aspect of having an IV, I will leave it in until a new site is started. Sometimes IV sites can be painful for a day or two before going bad, and you can use it in an emergency situation until IO or another peripheral is started. If it has gone bad -infiltrated or phlebotic, d/c it! You also need to follow your hospitals policies and procedures for guidance. Good job questioning practice. Sometimes questioning practice can bring about a change!
at the hospital I am a patient, if it is infiltrated then they pull it and put warm compresses on the area. then they get new access as soon as possible.
If IV is bad take it out, it can't be used,and it may be uncomfortable or painful for patient:bugeyes:. If it is infiltrated putting something in the line could cause patient more harm. If it is occluded trying to put something in line can dislodge a clot and cause harm. I would think that you would leave a line in until you have a new line, only if it is day to rotate site (every 3 days where I work).
i does not hurt to leave the infiltrated iv in. it is actually a good idea if you are not sure if the medication that is being given through the line may cause extravasation. you may need to give a neutralizing medication under the skin to prevent severe damage. this especially true with chemotherapy and other vesicants. if the line is only normal saline get it out and get a warm compress on it. if it is a vinca alkaloid give the appropriate neutralizer and get a warm compress on it. if it is alkylating agent or antibiotic vesicant give the appropriate nuetralizer and get a cold compress on it.
each institution has it own policy but research has shown the above to be the most effective way of dealing with this matter
The only time I would leave the bad IV in before I started a new one is if I was going to start the new site IMMEDIATELY. The rationale for this is that if you have to use the same arm to start the IV ( I prefer to use the opposite arm but this is sometimes not possible) when you put the tourniquet on the arm where you just removed the IV then it may start bleeding from the site because it has not had time to seal off. Otherwise I remove it right away.
UM Review RN, ASN, RN
1 Article; 5,163 Posts
Same here.
To me, as long as the patient has no complaint, the goal is to get something patent immediately. I can always pull the bad one later if I'm pressed for time.
Or, at my facility, we always have Techs who are hungering for the chance to DC an old IV, so sometimes I'll get the new IV and delegate the removal of the old one.
An infiltrated IV is a whole 'nother problem and I deal with that first, if it happens.