IV in AC

Nurse Ratched, RN · Jun 14, 2004

Thanks to all ER nurses! :)

I agree!

I'm quite sure as nurses, we are all plenty busy enough without plotting ways to make each other's lives miserable (psychomacia's tongue-in-cheek post notwithstanding .) Let's not war with each other - there are enough other battles to fight.

dphrn · Jun 14, 2004

Hmmmm....another way to "P" off the floor....he hee hhee...just d/c the IV before sendin' 'em up and tell 'em it infiltrated...yea...that's what I'll do if they gripe about the placement...let 'em start their own IVs...heehehehhehheee...next time you won't be takin' a break when I call, will you??? heehehehhehhehhehheeeehhehheehh.....

Perfect example of why there is discord between nursing departments. (Oh I know, you were probably joking) Break... have you ever worked on the floor? The nurse cannot take your report because she/he is more than likely with another of their 8-10 patients assigned to them.

How about caring about the patient and not having them have to be stuck again...what a concept.

Ridiculous and scarey that there are nurses who think like your above post.

P_RN, ADN, RN · Jun 14, 2004

Ridiculous and scarey that there are nurses who think like your above post.

Remember debate the topic NOT the PERSON.....keep to the subject.

dphrn · Jun 14, 2004

The only thing that comes to my mind is:

W O W !!

moia · Jun 15, 2004

I actually have worked so far..heh..er and CVICU and now as I am a broke down nurse on the IV team.

The AC is a truly crap spot for an IV. It is only good for a patient that is alert and cooperative. It is HELL when they are combative traumas and they wont keep their arm straight and the IV keeps stopping and finally you end up tying them down.

The absolute best spot for a huge monster is the back of the forearm...you have to put the iv in standing a bit backwards and it takes some practice and a little gymnastics but wow..it's comfortable for the patient and it's huge!!!

Guys seem to always have this monster vein that no one ever touches...it is rubbery and you must absolutely go really big...no 22's here..you will just bounce off.

The AC never lasts..it clots off right when you need it most or they put a 20 in and it infiltrates....a trick for when you MUST go antecubital...go high or go low...follow the ac up or down and then measure out where the catheter is going to end up...try to insert so the catheter doesn't get caught in the bend...it takes another moment of your time to feel where the ac comes in and goes out but it is worth it.

Even on the floor you can go ahead and try this...go as low as you can following the downword route of the ac...guarantees you nice big vein,,stable too.

You never have to stick right into the ac except when patients are circling the drain.

I too am happy when any patient arrives with any IV anywhere.

What I really hate......nurses who call the IV team to resite an IV without making one attempt to try themselves...every employee of my hospital was trained to start IV's...it was a really big deal..the nurses demanded it...it was "their practice" whine whine whine... call the union whine whine lots of snide comments to IV team members what are you going to do for a job when we start our own IV's? then the day came when they had to start IV's....oh well we don't have time...we don't have experience...don't we have nurses for that?

They fired the IV team...we are talking about a level one trauma center and heart center....big scramble...one IV nurse for days,one for nights...70 Ivs a day..50Iv's a night....floor nurses WONT start IV's at all

2 Iv nurses on days..one on nights...IV starts going crazy

Guess what...hospital scraps all Iv training for RN's...they aren't expected to do them anymore...except in the units and er.

Still I meet some who come with me for the start and I teach and they learn and I let them follow when they have time to get a little practice in...its funny but it is usually the older nurses or the brand new ones who want to come along.

I have worked many nights in the er and honestly I can say I have almost never put an Iv in the ac...there are easier spots and when patients are fighting getting into the ac is impossible but you can get into their forearm with some help.

A lot of our paramedic staff are trained to go immediantly for the ac so many of our patients arrive with sited IV's and thank god for them.

All our trauma's or criticals come with IV's and the majority are ac's...I can't complain as honestly I don't think I could start an IV in a moving vehicle with a critical patient.

Though I have to admit we have to resite alot...Iv's started under those circumstances usually don't last very long.

Rena RN 2003, RN · Jun 15, 2004

If I put one in there then the pt either needed it quick, or was volume depleted, or it was necessary for certain CT sudies.

and CT is the main reason i go AC. come in with c/o belly pain? at least a 20 in the AC. and i hazard a guess that at least half of my admissions are belly pain. if you have belly pain, you are likely to have either a CT or a surgery in your future.

come in with c/o chest pain? yep, you got it, at least a 20 and preferably an 18 in the AC. if you are going to need cardiac meds quicking, you're getting it in the AC.

come in with c/o headache? yep, you're getting the big ones. because if you turn out to be a bleed ........ well, enough said.

when i get a patient, i don't know what is going on with them so i have to assume the worst. chances are when that patient hits the floor we know whether or not that large bore needle was truly necessary. better safe than sorry, imo.

Jay-Jay, RN · Jun 15, 2004

As a homecare nurse, I find that patients being discharged home with saline locks in situ generally have them in the hand. Now, THAT is a lousy place for an IV for a patient who's up and about! They're using their hands a lot more than someone who's confined to bed, it hurts more, and the site is usually gone south within less than 24 hours, if not immediately. The worst, though, was the elderly patient (on Coumadin, of course!) who they sent home with an IV EXACTLY where his wrist flexed. What was the problem? Well, he used a walker to ambulate. Try doing that without bending your wrist. The site was blown by the time I got to him to hook up his IV abx, and I couldn't get it restarted, because his veins were so fragile. Eventually, I had to call in another nurse to help, and fortunately, SHE was able to get it.

Another pet peeve? The ER's that just cap a cannula off without putting on an extension tube and clamp to make it into a saline lock. Um...hello? What's going to stop it from clogging up with a blood clot? And you KNOW (or should know) nurses in the community all use the Interlink system. So, could we AT LEAST have an Interlink cap, or something with a luer lock on it, instead of that hard rubber cap that is NOT compatible with any of our syringes or Interlink needles? Thank you! You see, I really DO want to get home before midnight tonight....

missmercy · Jun 15, 2004

I agree that the AC is probably not the most comfortable site for an IV long term, they do sometimes get positional due to the flexing and extending that naturally occurs there -- however, I also know that the AC is a good vein to run things fast and furious through, and it is usually easy to access -- even in stressed situations! We, like others have stated, use them until they don't want to work any longer and then we move them. No big deal. I do agree that it would be greatly appreciated if there were an extension at the site as opposed to merely a hub -- makes life easier for all.

RN34TX · Jun 15, 2004

Just goes to show you can't please all the nurses all of the time...
But I'll take a chance and offer my "enlightening" reasons why the AC is sometimes the site of choice:
1. Easy to start when you're behind and up to you a** in patients who all think their "emergency" is the ONLY emergency in the place.
2. Some pt.'s actually prefer them since they may not hurt as much as some tiny little hand/wrist vein...to each his own...
3. When you have to draw your own labs (unlike most floors) you can't fart around trying to suck blood out of some 22g in a micro hand vein, just to have to do it over again when the lab calls and says "it was hemolyzed."
4. We often don't know what is really wrong with the pt, so a "good" line that is capable of whatever (meds/fluid/blood) we need it for and able to handle any amount is often started. Sorry if that doesn't fit in with your plans.
5. It gives us a way to get back at the floor nurses who seem to always be on break and "off the floor" when it's time for report from the ER. Who watches your pt.s when you're gone?? And why can't they take report when you're gone?? Perhaps if the floors stopped playing games with their census (funny how so many beds open at shift change), then maybe we would try a little harder to make your life easier...
Some of the above is in jest; some is not...
I'll let you decide which ones are/aren't.

A little off the subject, but I loved your comment about census games!! Since when has it become acceptable to refuse to take report because it's change of shift or the nurse is on break? I take report for other nurses when they are tied up. If I didn't ask all of the questions that the admitting nurse wants, she or he can call the ER back and ask.

I read the comments about AC IV's and I hate them as well and never could figure out why the ER loves to start them there but it makes a little more sense to me now.

But still...I've never worked ER, only ICU and maybe this is an ignorant statement due to the fact that I'm not an ER nurse but I have to say it:

Little tiny 22g IV's in the hand??

ATTENTION ER NURSES:

The AC is not the only place you can stick an 18 or 20g needle!! You're ER nurses for crying out loud, you should be good at IV's and not have to default to the AC every time. And yes, it would be nice if you thought about more long term use of that IV rather than your fluid bolus before you send them up to us.

There, I feel better now. A little immature, but better.

BittyBabyGrower, MSN, RN · Jun 15, 2004

ATTENTION ER NURSES:
The AC is not the only place you can stick an 18 or 20g needle!! You're ER nurses for crying out loud, you should be good at IV's and not have to default to the AC every time. And yes, it would be nice if you thought about more long term use of that IV rather than your fluid bolus before you send them up to us.
There, I feel better now. A little immature, but better.

That reminds me of the peds floor nurses that beg us to come up from NICU and start IV's and then gripe about putting them in a baby's head! Hello...you used up all the other available space! But, heck we are NICU nurses and we should be able to get an IV anywhere, right? :p

tiredfeetED · Jun 15, 2004

As a homecare nurse, I find that patients being discharged home with saline locks in situ generally have them in the hand. Now, THAT is a lousy place for an IV for a patient who's up and about! They're using their hands a lot more than someone who's confined to bed, it hurts more, and the site is usually gone south within less than 24 hours, if not immediately. The worst, though, was the elderly patient (on Coumadin, of course!) who they sent home with an IV EXACTLY where his wrist flexed. What was the problem? Well, he used a walker to ambulate. Try doing that without bending your wrist. The site was blown by the time I got to him to hook up his IV abx, and I couldn't get it restarted, because his veins were so fragile. Eventually, I had to call in another nurse to help, and fortunately, SHE was able to get it.
Another pet peeve? The ER's that just cap a cannula off without putting on an extension tube and clamp to make it into a saline lock. Um...hello? What's going to stop it from clogging up with a blood clot? And you KNOW (or should know) nurses in the community all use the Interlink system. So, could we AT LEAST have an Interlink cap, or something with a luer lock on it, instead of that hard rubber cap that is NOT compatible with any of our syringes or Interlink needles? Thank you! You see, I really DO want to get home before midnight tonight....

If im not mistaken when someone is discharged who needs IV meds they usually come off the floor??? Where is there PICC?

When puting in a line my attentions are to get a quick line in that will hold up for a few days..if i do have the time i will hunt down a ext. tube to make a j-loop. And when looking into my crystal ball, I see this person is going to need heavy meds for along period of time..ill ask for a triple lumen....but not likely.

Even if you have a j-loop you still need to routine flush those lines to keep from cloting, exp without hep-flush. And Interlink cap. ( We use what we have)

And that frail elderly person on coumadin had a line in there hand because the person starting it ran into the same problem you did!!! lack of good veins! No matter where that line will be..it must be watched close those will infiltrate in AC, Forearm, ETC. and wont alarm the pump! Damn i love the ER!

tiredfeetED · Jun 15, 2004

A little off the subject, but I loved your comment about census games!! Since when has it become acceptable to refuse to take report because it's change of shift or the nurse is on break? I take report for other nurses when they are tied up. If I didn't ask all of the questions that the admitting nurse wants, she or he can call the ER back and ask.
I read the comments about AC IV's and I hate them as well and never could figure out why the ER loves to start them there but it makes a little more sense to me now.
But still...I've never worked ER, only ICU and maybe this is an ignorant statement due to the fact that I'm not an ER nurse but I have to say it:
Little tiny 22g IV's in the hand??
ATTENTION ER NURSES:
The AC is not the only place you can stick an 18 or 20g needle!! You're ER nurses for crying out loud, you should be good at IV's and not have to default to the AC every time. And yes, it would be nice if you thought about more long term use of that IV rather than your fluid bolus before you send them up to us.
There, I feel better now. A little immature, but better.

That reminds me of the other day when i sent a patient to the TELE floor with a 18 ga. in the hand...They said i was mean...They will thank me later when there pushing D50, Atropine ETC....lucky i couldnt find any 14 ga..laying around! I like the comment "You're ER nurses for crying out loud" Your Damn right!!! Everyday im amazed at the talent of coworkers with a 18 ga. ..and shake my head at some others!

I applaud you for taking report for your coworker! sometimes when i get the lunch, busy comments...i wonder where the Teamwork on the floor is...Thats another reason i love the ER...