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'm a newbie but may can give reasons for my facility. I was taught that if the IV is infiltrated policy is to leave it in...reason being is that if what was infuisng or being pushed is something that causes irritation or tissue death such as K, then the existing IV site must be used to dilute...example...we have a protocl to follow for IV infiltrates....if it causes harm to the patient...IV vanco or K we must first infuse 10cc NS to the infiltrate, then call IV team who then comes and asses and treats the infiltrate. If, however, the IV site is occluded or the area is reddened, we can pull it.....I cant remember what it is the IV team uses for vanco infiltrates..just know that it MUST be treated and DOCUMENTED!!!!!! We had an IV team at my facility and the nurses varied on what they wanted us to do...if it ws red I pulled it...one IV nurse said not to...reason is that they must start a new IV above the one that was occluded...makes sense, but they should be able to see where the old one was!?? hope it sheds a little light and makes a little sense.
The only time we have been instructed to leave an old IV in place is when doing a site change every 3 days and the old one is still patent/working. The rationale is that should we need to give something right away/in an emergency we have a functioning line. I also do it because I figure if I take it out before I start the new one and then I can't get a new one going, and another nurse can't either I could be putting the client in danger.
If the line is clotted/infiltrated etc. we are taught to d/c it first.
The standard that the courts go by is the Standards set by the INS (Infusion Nurses Society) the standard says that an IV will be removed as soon as there is a problem with it such as infiltration, clot, pain, redness. So what would a prudent nurse do? Of course remove the IV. There have been times I have left the IV in and before restarting and this is if I am going to use the same arm and go above the old site, I do this so the patient does not get a hematoma from the pressure of the tourniquet.
As soon as signs of infiltration or extravasion are seen, the iv cannula is removed from our Nicu babies.... Before siting a new cannula. Ever seen a TPN burn?
An infiltrated or occluded IV is NOT better than nothing. It is the same as nothing. You do not have a working IV site. Period.
Imagine being in court and the lawyer says "Please explain why you forced fluids thru an IV that was already infiltrated, resulting in pain and suffering to my client".
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.
IF I'm replacing it because it hit the 72 hours and needs to be replaced then I usually leave it in until the new one is in. However, if I'm replacing it because it's occluded or infiltrated I definitely take it out first. One thing about nursing school though - follow the instructor just because you need to to pass. It's been awhile but I still remember people being dropped because they "can't follow instructions". Thinking for yourself is a wonderful thing and will serve you well. On a good day, it's what nursing is about
Assess the site first. Best practice is to remove the occulded catheter if it is truly occulded. Sometimes the tip of the IV catheter may be resting against the side of the vein or maybe it is taped down too tight thus impeeding the flow. Never force flush a catheter. :paw:
Next, if the IV infiltration occured while infusing an vesicant, prior to D/C of the catheter check with the MD or Pharmacy (per your hospital policy) to ensure you do not need to administer any medication via that line into the surrounding tissue to decrease tissue necrosis. Otherwise if no vesicant was being administered then D/C that line promptly, this reduces any further damage from occuring. :paw:
Bottom line: Imagine yourself being in a court of law trying to explain to the Judge or angry family members why you left a non-functioning IV in place-good luck!
next, if the iv infiltration occured while infusing an vesicant, prior to d/c of the catheter check with the md or pharmacy (per your hospital policy) to ensure you do not need to administer any medication via that line into the surrounding tissue to decrease tissue necrosis. otherwise if no vesicant was being administered then d/c that line promptly, this reduces any further damage from occuring. :paw:
according to the ins the latest policy for infiltrated vesicants is, to aspirate as much as you can through the iv angiocath , then remove the catheter. the antidote should not be given through the angiocath but injected percutaneously around the area.
Thank you for the detailed response. My response was meant to be general. Treatment varies as you very well know, by hospital, Physician, pharmacy, drug administered etc. That's why I made reference to their hospital policy as not all places inject medication into the tissue,(should they? that's a different story) some have used topical nitro, cold compresses etc. Reviewing the hospital policies & procedures is always a good place to go to look for answers. INS also contains a wealth of knowledge. Great reference.
I have worked cardiac for the last 12 years and I always leave the old one in until I get a new site. My reasoning is that I use the old site as a marker. By leaving it in, I know not to use that area re: wrist, hand, inner forearm, etc. I always ask the nurses that ask me to try their IV's to leave the old ones in for the same reason. But that's just me. I can understand why the hospital class told you to remove it ASAP in case of emergency.
I also have seen some pretty gruesome craters, and amputations from IV infiltrations, so I tend to pull asap. The most memorable one was a newborn that lost 3/4 of his right arm r/t a gent infiltration.
In certain situations, if I had to leave it for some reason, I would do as others described and taped over the port and put NO on it until it could come out.
I've been helped so much on this site, thought i would try to return the favor.
lorabel
63 Posts
I'm a newbie but may can give reasons for my facility. I was taught that if the IV is infiltrated policy is to leave it in...reason being is that if what was infuisng or being pushed is something that causes irritation or tissue death such as K, then the existing IV site must be used to dilute...example...we have a protocl to follow for IV infiltrates....if it causes harm to the patient...IV vanco or K we must first infuse 10cc NS to the infiltrate, then call IV team who then comes and asses and treats the infiltrate. If, however, the IV site is occluded or the area is reddened, we can pull it.....I cant remember what it is the IV team uses for vanco infiltrates..just know that it MUST be treated and DOCUMENTED!!!!!! We had an IV team at my facility and the nurses varied on what they wanted us to do...if it ws red I pulled it...one IV nurse said not to...reason is that they must start a new IV above the one that was occluded...makes sense, but they should be able to see where the old one was!?? hope it sheds a little light and makes a little sense.