Do you stop infusion "for a walk?"

[rkitty198]

"I want to go for a walk and a shower," "will you unhook me?"

Do you stop the IV infusion to allow the patient some freedom?

Times where it really bothers me:

-Patients who are on PCA's who want to go out to smoke (which we have sign a consent for leaving the building).

-Patients who need an IV abx and will have treatment delayed until they are ready.

-Those who have peripheral IV's which end up infiltrating, leaking or falling out which adds more time to my day because I have to put in another IV, which then delays more treatment.

-I am stopping an infusion which is a doctors order

-I have to get back into the room asap to restart the infusion (PCA's, ABX) because going for a smoke puts the patient in a pain crisis and then suddenly they need their PCA again.

(by the way, we do give nicotine patches for those who smoke, and we have them sign a consent when they leave the floor)

What is your practice?

I am starting to think about saying "no."

[psu_213, BSN, RN]

Today, my tech called me to see if she could stop the infusion to help get a patient to the bathroom. I thought of what some of you said in this thread and said, "no, because it increases the chance of infection," but I offered to come help her get the patient to the bathroom.

I think that if your disconnect the infusion, cap it with a 'dead end' cap (in my facility they are blue..I've seen red other places), they walk to the BR; when the get back you scrub the hub, flush the catheter, hook back up the infusion. Minimal infection risk. I'm certainly not going to unhook the pt from all infusions all the time to go the the BR (a dilt gtt would be an example of one that I would not unhook), but it can be alot easier for a pt to get to the BR without the pole, pump, etc. In addition, I do not want the pt using the precense of the pole as an excuse preventing them from regular ambulation.

[rn/writer, RN]

I do not like the idea of letting someone with a PCA go off the floor at all. The one exception would be for a c-section mom to visit her baby in the NICU, and then I would insist she use a wheelchair and have someone with her.

But to go outside for a smoke? I don't think so. First, there's the liability issue. If they fall, you can bet there will be all kinds of questions about why someone on PCA narcotics was allowed off the floor/out of the building. Second, the neighborhood where I work (noc shift, BTW) can be scary. Maybe having a syringe full of morphine or hydromorphone wouldn't be all that tempting to anyone. But who knows. It just doesn't sound like a good idea.

We offer help to quit and do make people sign liability waivers. I'm just not sure the paperwork would hold up if the person was already on the PCA when it was signed.

[K+MgSO4, BSN]

The ward that I work on we don't unhook for showers or anything. We thread the IV line and bag through the sleeve of their nightgown or whatever and they can leave it on the otherside of the shower curtain. You need the IV for a reason. You are keeping it running.

[hecallsmeDuchess]

I can unhook fluids if it's normal saline but no for any other kind of IV medication. Most patients I've had don't even want to get up even when they can, they seem to think they have come on a relaxation tour (this does not include those with legitimate pain or mobility issues). On our floor, patients need a doctor's orders to shower and most don't have orders and when they ask for a shower (they rarely ask), I offer to get them a basin so they can wash up. Those that want to smoke, if they tell me that's what they plan on doing, I don't disconnect them even when the fluid is normal saline, I just educate them on the dangers of smoking. Most already have this lecture before so they often say they want to go to the cafeteria and they come back reeking of smoke. Arghhh!

We also have to cap off IV tubes with their special caps when we disconnect it from the patient to decrease the risk of infection.

[Up2nogood RN, RN]

I am definitely not unhooking a pca so the pt can go out to smoke. We are a non-smoking facility that's enforced. They need an okay from the MD to walk out that far and if they're feeling that good than it typically calls for a PCA d/c and they are offered a patch. I had one pt literally sneak out down the elevator all gorked on a dilaudid pca and fall down outside, security found her before we even knew she was missing.

If they have IVF running they can take a shower with it, we have big bathrooms. There's the infection risk that someone else mentioned plus I tell them the Dr ordered xyz infusion for whatever reason and I don't usually make concessions. I have enough to do with really ill pts that I don't need to waste time unhooking IVs at the pts whim.

[OCNRN63, RN]

I must disagree with this. All patients should be walking (if feasible), especially post op pts. I don't think it's fair to pts to say that if you can go for a walk without your NS then you can go home.

My view on this:

IV antibiotics--they can wait 30 or 60 minutes until the infusion in complete

Heparin or some other type of other continuous gtt--no, must stay running

PCA--can we even let them go outside with the PCA drugs?

Fluids--for they most part, they can go without them

If someone is well enough to have their IV disconnected so they can go smoke, then yes, they are well enough to go to a lower level of care...most likely home. Good grief, people get D/C with all sorts of medical equipment. There's no reason IV therapy can't be done at home (I know, I did home infusion).

I never said they couldn't walk. There's just no reason to disconnect them to do so. I know patients should be walking; I had Nursing 101 a long, long time ago.

[Jenni811, RN]

Um, i would say no not at all (even NS running TKO). Only way i would is if i had a doctors order. Just sayin...it's my license and it takes 1 simple mistake to have that taken from you.

[Up2nogood RN, RN]

Mini vent related to this thread:

Today, my tech called me to see if she could stop the infusion to help get a patient to the bathroom. I thought of what some of you said in this thread and said, "no, because it increases the chance of infection," but I offered to come help her get the patient to the bathroom.

I told my preceptor I didn't allow the tech to unhook the fluid for toileting and she lectured me saying she allows patients to be unhooked for the bathroom. She said, "while unhooking increases the risk for infection, not unhooking increases the risk for falls."

p.s. The next time the patient needed to go to the bathroom the tech phoned my preceptor instead of me and the infusion was stopped

Got frustrated. Vent over. Thanks for listening.

Why in the world should the nurse have to disconnect the IV for the pt to walk to the toilet when the tech is there to help? Is it too much for the tech to unplug the IV pole and walk the pt to the bathroom?

ETA: and the tech shouldn't be unhooking any type of IV infusion. I've never heard of that being in their scope of practice, I believe that's always been a licensed nurse duty.

[cogath]

In clinical, NO. We walk them with the poles and everything. Also shower and take the gown off without disconnecting them.

[rachelgeorgina]

I would have thought that it's not a clear cut issue and would depend on a multitude of factors beginning at least with the patient's condition, what the drug is/why it's running in the first place. I wonder if it might be slightly too black and white to have a cut and dry answer without considering individual situations.

[noyesno, MSN, APRN, NP]

Some of you got me thinking, "unhook if it's just fluids," but I'm still sort of torn because my issue is really with the increase infection risk/messing with the IV site.

Today, I followed up with the tech on the issue. Before I could get into it, she explained that they just had a meeting on this and were told they should not be unhooking for any reason and she agrees that unhooking is not good. I think I'm going to stick with the not unhooking unless it's absolutely necessary.

Sorry if I'm highjacking. Will stop now. xoxo

[rkitty198, BSN, RN]

I normally unhook for showers, but these neutropenics keep wanting the full connection stopped to walk! I have been documenting like crazy:

Pt wants to be unhooked, educated the risks involved and pt still wishes to be disconnected.

What do you guys think?

Oh hijack away, I have learned so much from you all!