I am newer to home infusions. I have a L and D background. I feel stupid asking, but you don't know if you don't know, right? I have a patient that prefers his IV in his left AC. I've never had a problem with his IV before, but yesterday it blew as soon as I got my flashback. The other side did the same thing! His mother asked me if I could come back tomorrow and try again, she said she didn't feel comfortable with me "poking" him again. So my question is can I try to start his iv in his AC again? Is 24hours enough time for the vein to heal? At this point can I go below yesterday's try? I've never tried to go about the AC before. Any knowledge would be greatly appreciated. I've never had this happen before and I'm a bit devastated 😞
Aug 10, '17
I would explain to this patient that having an IV catheter in the ACF is not a good idea. The damage to the smooth bed of endothelial cells causes the start of phlebitis and thrombosis secondary to its location and arm bending. Many times when patients know why you don't want to use the ACF vessels, they will work with you.
Sep 2, '17
IVRUS is correct. Ideally, these are blood drawing veins and should not be used for routine IV therapy especially planned IV therapy. I would guess the patient requests it there because they have had bad IV experiences and have come to believe this is their best chance at a one attempt access. Are you good at IVs... if so time to educate your patient and caregiver and then show them there are many more good IV sites to be had. As far as using the Acf again the next day it is patient specific and depends on how much trauma the vein sustained and how much bleeding occurred at the site.. If patient has a large hematoma and there is no good section of the vein you can see and/or palpate then you should od not go for it. If it looks healed and is mot tender and you can see or feel a good section then go for it and try to go above the poke site the day before if you are able. This is all assuming you must use the ACF for whatever reason. Please bring g a medical heat pack or use one of those you can heat up in the microwave if you are having difficulties finding veins. Yes you can go below your attempt If the section of vein above it is not traumatized. If the patient has any clotting difficulties you could have an infiltration or extravastion if the section of vein that was poked leaks. What you do is all based on the assessment of the veins prior to venipuncture and your ongoing assessment during the infusion
Sep 3, '17
If this is an on-going case, would having an implanted Infus-a-Port be a possibility for this pt?
Not sure how young the pt can be for one.