Is this true?

jdub6 · Sep 24, 2016

Muno, Muno, Muno..... Why you have such an aversion to INS standards of practice, I'll never know!!! However, while INS Standards of Practice aren't mandatory, and aren't laws per se', they SHOULD be used to measure clinical practice both in and out of a court of law setting.

So, with that said-and this is a serious question-where do you place your PIVs then? I'm assuming as an IV therapist you see plenty of pts with less than ideal veins. So take those same pts and now assume you're not the IV nurse who is trained and authorized to use ultrasound and place PICCs and other tricks. You're now a floor or ED nurse getting an admission needing peripheral access ASAP. Can you list your go-to spots that you look at?

And if the only available sites are in places like the AC or that "interns vein" of the wrist, would you use them? Say you can't get anything in your ideal spots but can get a perfectly respectable 18 or 20 in the "bad" spots, what would you do as a floor nurse? Place the PIV and start the blood/ fluid/ antibiotic or tell the MD you can't and ask for a PICC-or place it and tell the MD that even though you have a PIV that's working you want a PICC due to the site you had to place the peripheral?

UnbrokenRN09, BSN · Feb 14, 2017

I never stick these areas unless they have a very prominent palpable vein and there isn't anything else. If they require long term access, vesicants or irritant medications then they should have a midline or picc as soon as it's feasible.

I dont think these "standards" are laws, but they should be taken into consideration in non urgent situations.

Flatline, BSN, RN · Feb 27, 2017

While professional standards are not laws they are the clinical standard you will be judged against in court and by the board of nursing.

You know the whole "reasonable and prudent" thing you always hear about? To make it less subjective the standards issued by professional organizations is what every nurse is judged against, especially the INS considering their prominence. You do not have to believe me, look up case law on infusion therapy and read just how many times the INS standards are referenced.

Here is a hint, many of the expert witnesses used in infusion therapy related malpractice cases are also authors or contributors to the INS standards

brownbook · Feb 27, 2017

Really interesting. Of course if the patient is going to die the IV goes any where.

Having worked ambulatory surgery 17 years, starting IV's on pre-op patients, my first reaction was "no way man!" And how could this be a real and present danger when millions of patient's have peripheral IV's in "places to avoid" and I've never heard of any nerve injury damage?

I did read Peripheral nerve injury from intravenous cannulation: A case report. I was ready to roll my eyes. But it is brief and well written, (plain English). It even explains why it may happen more that I realize due to under-reporting and the delay of symptoms.

I think we can all agree with prevention strategies. "If paresthesia is elicited on insertion of a catheter at any site, the catheter should be withdrawn immediately. If a patient complains of numbness or tingling at the IV site, remove the catheter promptly. When inserting an IV catheter, limit probing at the site. Finally, when and if nerve damage is suspected, consult a hand specialist promptly. Early recognition of nerve damage leads to the best prognosis for recovery."

iluvivt, BSN, RN · Mar 3, 2017

An employee where I work had an IV in the wrist in the "area to avoid"and now has permanent nerve damage.She wears a splint every day to minimize the pain and this has had a permanent effect on her life and her abilty to work.You bet it happens! You must study where the nerves are especially in tbe ACF area so you can avoid them and must assess PIV sites diligently. If a patient is complaining of nerve=like pain please resite the PIV.I cant tell you the high number of patients that tell me their nurse refused to relocate the site because it still looked good!