restarting prehospital IV's

Specialties Emergency

Published

We don't restart them unless there is a need. I have heard that this is a practice others places, but I have yet to find and studies that actually states that IV inserted in the field become infected more often than those put in in the hospital.

Specializes in Community Health Nurse.

Every hospital I've ever worked in stated to change field IV sites within 24 hours, but if the patient is coming from another hospital with an IV already in place there is no need to change the IV site as long as it is patent and intact without any infection noted around the site and so forth. :)

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our hospital policy changed to squad stick changed within 24 hours because of sentinel event in which the patient lost an upper extremity due to an infected IV site. before that, policy was to change all IV site q72h regardless of origination of start.

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our hospital policy changed to squad stick changed within 24 hours because of sentinel event in which the patient lost an upper extremity due to an infected IV site. before that, policy was to change all IV site q72h regardless of origination of start.

OK thanks...this likely explains why most hospitals have policies on this issue...a sentinel event triggered it. Shoulda guessed. ;)

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Hows this for one. My hospital (work in the field if the name didnt give it away), the hospital's paramedics lines are not changed, but if any other paramedic service brings it in they are changed at 24 hours.

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We're required to change any field sites within 24 hours, citing infection risk as the reason.

yeah, that... :D

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i am not sure how i feel about that policy.

what if it is that is the only line you can get at the time on the patient?

are you required to change the line directly upon admission to the er? or can they wait til they go to the floor?

my feeling is if the pt is admitted, then change the line in 24 hours but let the floor do it.

i just wonder, we have a lot of ems personel working as techs and nurses in the er. if they start a line at work, do we have to restart it? not to be flip or anything, but think about it.

on the other hand, a line started in the field isn't started in the same environment. the er is clean verses the out doors, peoples filthy houses, etc...

anyway, just some more thoughts. :balloons:

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Specializes in Tele, Home Health, MICU, CTICU, LTC.

I've never really understood this policy. I worked EMS and we use the same standards for site prep as the local hospitals do. Now I work in the hospital and our policy is to restart EMS IV's after 72 hours.

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on the other hand, a line started in the field isn't started in the same environment. the er is clean verses the out doors, peoples filthy houses, etc...
I think I'd rather have the field stick in me. The hospital is the filthiest place you can be (hence nosocomial infections.)
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Specializes in ER.
i am not sure how i feel about that policy.

what if it is that is the only line you can get at the time on the patient?

are you required to change the line directly upon admission to the er? or can they wait til they go to the floor?

my feeling is if the pt is admitted, then change the line in 24 hours but let the floor do it.

i just wonder, we have a lot of ems personel working as techs and nurses in the er. if they start a line at work, do we have to restart it? not to be flip or anything, but think about it.

on the other hand, a line started in the field isn't started in the same environment. the er is clean verses the out doors, peoples filthy houses, etc...

anyway, just some more thoughts. :balloons:

I don't think it is so much about the person who started it as it is the environment it was started in...as you mentioned...dirty houses...etc...Where I used to work the policy was change it after 24 hours....how we usually approached it...Is if the patient needed additional blood work or needed to be stuck again for any reason...we would just put another line in...if it was impossible to get a second line in you got an order from the doctor it was okay to leave the pre-hospital line in...and on the matter of waiting til they get to the floor to get the new IV...having been both a patient and a caregiver...would you rather have the nurse that sticks 10-20 times a day put your IV in or the nurse that sticks 10 times a week? (That is nothing against the floor nurses...) In my current practice, and hospital...we are not required to remove pre-hosptial lines anymore within 24 hours...it is now treated like any other iv and you check it q shift and with each infusion like you would do for any other IV site...I would be interested to see if there was ever a study that should higher rate of infection with pre-hospital lines vs in house lines....

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Specializes in ER.

IV starts here are q72 hours. EMS starts are changed in 24 hours.

We still have an IV therapy service who does all the restarts and checks each IV in the place daily. The infection rate here is something like 1/20 of the national rate and they point to the IV therapy service as the reason.

Of course, the ER, ambulatory surgery, and some other places are able to do their own starts. But the average nurse here doesn't.

Chip

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