IV in AC

webbiedebbie · Jun 14, 2004

I would say so! The only thing I got out of it is that it is "easier" to start one there and it seems to be easiest access. (Understand this is why EMS uses this site). I was taught to begin at the lower site (hand, wrist, forarm). AC is the last place we use if unable to obtain in other areas.

Everytime the patient bends their arm, it cuts off the IV. AND, I have been told that it is painful in the elbow by patients. IV's hurt no matter where you put them! Not to mention the fact that it hurts them again because I have to restick them. I'm a busy nurse too, so I don't buy that reason...not to mention the added cost to the patient and increased risk for infection. I will accept the cardiac reason for medications, though.

IamRN · Jun 14, 2004

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."

I usually work ICU, but I float to the ER. The nurses there taught me to collect my labs when I start my IV. I use mostly 20 G and have had no problem collecting them at the time of starting the IV. Everybody gets drawn a "rainbow." I have needed to start a 22 and that works well too.

SmilingBluEyes · Jun 14, 2004

Lord, do not let this be an ER versus Med-surge unit war! We have had a lot of those already. If you need to change the location, you do it. I agree, sometimes in emergent situations, the AC space is best in most people for drawing ones own labs (we do our own labs in OB all the time) and on people with crap for veins. It's just another situation where people, not understanding the other units/floors are unhappy with how things are done elsewhere and griping. In my situation as a patient, admitted for urgent surgery last winter, they started my IV in my AC space, too. I Hated it, had to keep my arm straight, but I understood the emergent situation in my case, and knew they needed not to waste time looking for the perfect hand or arm vein, only to blow it in the case of my sorry veins. An AC IV hurts a hella lot less than one in the hand,and there is a lot less chance of nerve damage there, too, so it's not the worst place an IV can be started, IMO.

Let's just say, unless we are in the other nurses' shoes, we may not know the whole picture and leave it at that. Med-surge nurses are NOT always on break when ER calls an admit, and ED nurses do NOT start AC IV's to (*^% off M/S nurses. OK?

webbiedebbie · Jun 14, 2004

Wow! I didn't mean to tick some people off! I wanted a better understanding of why IV's are started in the AC. I truly understand the emergent situation! I was hoping to let others walk in my shoes, too.

I too, as a patient came to an Emergency Room. I was not emergent. The ER was NOT busy. My IV was started in the AC and when I asked to have it started lower I was told this was the only place where they start them.

SmilingBluEyes · Jun 14, 2004

IT definately helps when communication goes both ways. I guess a bit of understanding the others' jobs is always helpful. No ONE "always" does anything this way or that, and I think when someone uses that word, the tone is set the wrong way and people get defensive. I guess we all have a better understanding now why ED does things they way they do, and how inconvenient AC IVs can be on the floors. I think it's best left at that.

hock1 · Jun 14, 2004

When I did my IV rotation in the ER I asked why the AC site was so popular in ER and told them what a pain in the a*s they were on the floor. I was told that this site was fast and easy for them. I could certainly understand the plight of the ER cuz they had people lined up and down the hallways.

tiredfeetED · Jun 14, 2004

Forget the AC..I love sending them up with a 18guage in there neck!! jk

Took me along time to get a comfort level even starting a line in the AC...just something that sticks out from school was to start distal and work up the arm. Me personaly i like the hands..but damn..looks like they hurt..

I spent a year on tele and remember all those beeping pumps from the iv's in the AC..but in emergent case..if they have a vein...watch out... :)

IloveSnoopy · Jun 14, 2004

I think it's just a blessing to have patients come from ER with a line already in!!! Thank you!!! Many times I'll get a patient from ER that needs an IV, foley,etc. .....it's very,very hard to get all this stuff done, admit them, do all the paper work junk, and care for my other patients. If the site looks good and isn't hurting the patient...I just leave it. Thank you ER nurses for putting lines in before the patient comes down...it's truly a God send when you are busy. I'm not that picky about sites....AC is a great place to have a line when you have an unstable patient, one that may go to OR, or needs fluid boluses pushed in fast. Just my two cents worth... :)

Luv,

Snoop

Nurse Ratched, RN · Jun 14, 2004

I actually miss starting IV's since I'm not FT at the hospital anymore. Had to change one out recently on a patient whose HW was infiltrated but still needed for telemetry purposes. Horrible veins and tremendous scarring over both arms r/t a derm condition. Tickled me to no end to find a little one in his dominant hand's wrist that was not as conveniently located as it might be, but I *did* get it in one lucky stick. (slightly off-topic, but only here can one get the understanding associated with hitting a vein you had no business getting.)

I guess we take what we can get. As others said, in the ED/ambulance, they understandably just want the biggest quickest line they can find. I find the arm boards pretty handy if there are no other vein options. Most times, tho, if I add up the time I spend running back and forth to pt's rooms to press the reset button, it's less time to just change the site (and good practice :).)

psychomachia · Jun 14, 2004

Lord, do not let this be an ER versus Med-surge unit war!
It's an AC vs other IV sites war....
Med-surge nurses are NOT always on break when ER calls an admit, and ED nurses do NOT start AC IV's to (*^% off M/S nurses. OK?
OK. But apparently it's OK to gripe about ER nurses and not about med-surge?? Like I said before, some of it was in jest, some not...If I hit a nerve, perhaps I wasn't too far off the base...or maybe your retort was in haste and you didn't read what I wrote???

psychomachia · Jun 14, 2004

I think it's just a blessing to have patients come from ER with a line already in!!! Thank you!!! Many times I'll get a patient from ER that needs an IV, foley,etc. .....it's very,very hard to get all this stuff done, admit them, do all the paper work junk, and care for my other patients. If the site looks good and isn't hurting the patient...I just leave it. Thank you ER nurses for putting lines in before the patient comes down...it's truly a God send when you are busy. I'm not that picky about sites....AC is a great place to have a line when you have an unstable patient, one that may go to OR, or needs fluid boluses pushed in fast. Just my two cents worth... :)
Luv,
Snoop

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.....

Long Term Care Columnist / Guide · Jun 14, 2004

Frankly, I don't care WHERE the IV line is when a patient comes up to the floor........I'm just grateful someone took the time to put one in, as we don't have an IV team and we floor nurses have to start all our own IVs if pts. don't have a line when they come up. If I don't like the location, well, I'll deal with that later.

It's not that I mind starting them......in fact, I'm very good at it, but we have a fair number of nurses who aren't, and I end up starting or changing not only MY patients but theirs as well, which takes time away from my appointed rounds. So I'm really happy when ER puts in the IVs, and the Foleys, and the NGs......Thanks to all ER nurses! :)