IV in AC

rollingstone · Jun 15, 2004

ED nurses put IV's in the AC because it's usually the most visible and best vein. Experienced nurses can access this site fast which is a plus if you work in ED. When I receive a pt from the ED and they have an AC IV I'll ask if they'd like it removed and the IV restarted in a more comfortable spot when I've got a couple of minutes to do so. Not a big deal for me. I'll do what the pt wants.

Jay-Jay, RN · Jun 15, 2004

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

Nope. Most commonly in the community, our abx. patients have cellulitis. Their PCP sends them to ER, they get one or two quick doses of Ancef, and are d/c home with a saline lock, and orders for Ancef via CADD pump Q 8h X 3 days (7 if the cellulitis looks really nasty.) And yeah, I'd LOVE to see a PICC line, but generally only the Ca. patients get them.

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 clotting, 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!

We usually only do saline flushes. Heparin is most often used for PICC lines. Again, most abx. patients are on CADD pumps, and don't require flushes. If the abx is intermittent, we teach family to do the flushing.

As for the elderly guy with the cannula in his wrist, he had LOTS of good veins on the forearm, but I kept blowing them. Maybe it was because it was late at night and I was tired, or I was using too high a pressure with the tourniquet. I dunno. But whoever placed that IV was NOT thinking ahead. I'd just like to see some co-ordination between the hospital and community, that's all. It would make everyone's job easier. Some ER nurses know all about CADD pumps, others....well.... :uhoh3: A few weeks ago, I sent a pt. to hospital for an IV start. The pump was all set to go, all you needed to do was turn it on. (I sent an Interlink extension tubing with her too!) I showed the patient how to turn the pump on, and she practised doing it to make sure she got it right. ER says: sorry, not comfortable with this! So she had to hang around while the gave it to her by gravity!

Please, le'ts not take the comments in these replies personally. We just need to vent! :)

missmercy · Jun 15, 2004

Nitwit ideas are for emergencies. You use them when you've got nothing else to try. If they work, they go in the Book. Otherwise you follow the Book, which is largely a collection of nitwit ideas that worked.

-- Larry Niven / The Mote in God's Eye (1974)

I LOVE this quote :)-- as JACHO survey time approaches -- it is especially heart-warming!! :rolleyes:

BTW -- we have a number of chemo patients that have mediport devices implanted for IV access -- these patients love them!! Catheter actually enters venacava and port can last a really long time. No peripheral sticks -- if your ER staff/ floor staff / whoever -- is trained to use them.

sharann, BSN, RN · Jun 16, 2004

I am so happy when we get a pre=op pt from ER with ANY IV access! Thank goodness they had the sense and/ot time to put one(anywhere is fine). I only get upset when th pts come down from the ICU for a CABG with a #22 saline lock in the hand started 5 days prior(and is infiltrated and filthy). The ED is not the place where they have the luxury of time to go vein hunting, especially when the surgeons are screaming "get them to OR/CT/etc... adn the pt is hypovolemic and has no veins.You GO ER nurses. I love you guys and gals(Because I would shoot myself if I had to do what you do every day. You are my heroes)

Dixielee, BSN, RN · Jun 16, 2004

Despite all the bickering between the ER nurses and the floor nurses, I, as one ER nurse thank all the floor nurses here who have responded positively and understand that we all have a certain job to do, and that is to do the best job for the patient at the time. We are all busy with our individual duties and no one wants to duplicate tasks, but I think this discussion has been a good one for both sides to understand the other. As for floor nursing, I did it in school 30 years ago, and would not do it again. I have floated a time or two (kicking and screaming all the way), and my hat is off to the floor nurses who do it day in and day out. I could not, would not do it. I don't think I am a burned out cynic, because I love what I do in the ER, but I could not take care of folks long term on the floor. I have worked in hospitals where the RN was responsible for 15 or so patients at night. Heck I can't remember the names of the 4-5 I have at a time. We get criticized for refering to the "belly pain in room 5, or the GI bleeder in 7, but sometimes that is all I can do. We all deserve a medal for hanging in there 24/7 taking a beating and going back to work day after day, year after year. If this is some small consolation, I read recently in a poll conducted to see which professions are high on the honesty scale, nursing continually comes out very high on the scale. Thanks a lot to all of you who keep your chins up, keep the smile on your face and do the best you can to heal the sick and afflicted. It is not an easy job and sometimes thankless, but we have made our mark and will continue to do so. Carry on!

angel337, MSN, RN · Jun 16, 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.

:rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl:

angel337, MSN, RN · Jun 16, 2004

the reason why my ED place iv's in the ac is because if a person needs a ct of the abd or any other test that require iv dye, they want a 20 or 18g in the ac. it is alot easier to just put the iv there instead of starting all over again when ct calls and says "we need a 20g or less in the antecubital". and also the iv starts better in the ac and you get better blood return. just my 2 cents..... :)

Dixiedi · Jun 16, 2004

Anyone else frustrated by getting patients from ER with IV's in the antecubital? Nine times out of ten we have to pull them and restart the IV. Patient's don't like them there and can't bend their arms. I know it is easier for paramedics to start them there, but I'm not sure the reason for ER to start them there. Perhaps someone can enlighten me?

Something must have changed since I last worked in hospitals. Granted I have done home care, correctional care and LTC facilities and took a sebatical since I last worked in the hospital.... However, when I worked hosiptal any IV coming up from the ER or outside our facility was always deemed contaminated and we changed the site. Do they leave them in now?

jwk · Jun 16, 2004

the reason why my ED place iv's in the ac is because if a person needs a ct of the abd or any other test that require iv dye, they want a 20 or 18g in the ac. it is alot easier to just put the iv there instead of starting all over again when ct calls and says "we need a 20g or less in the antecubital". and also the iv starts better in the ac and you get better blood return. just my 2 cents..... :)

If a good IV in the AC is all you can get, fine. From an anesthesia standpoint, we hate AC IV's. They have a bad habit of getting kinked at the wrong time, and are harder to secure because of the bend in the arm. IF there is time, we would much rather have one in the forearm (1st choice) or the hand (2nd choice). I hate seeing AC IV's when there are great veins more distally.

Also, I wouldn't let the radiology department be the determining factor for IV placement. If you have a good 18 in the hand, do you start another IV in the AC just to satisfy their policies?

Jay-Jay, RN · Jun 16, 2004

Both times I've needed contrast media for a CT study, they started the IV in my hand or wrist. The hand hurt like you wouldn't believe...I yelled as the media was being injected! So, they don't always demand a line in the AC....

Loribabble · Jun 16, 2004

I love it when our ER sends pts with an IV - I don't care where as long as they have one... a large portion of our pt population are IVDA'ers and while I can usually count on getting a line in myself - it really helps. We have had several pts sent to us from ER... seizing, decreasing BP, horrible sats etc, with NO line - and that really makes me upset. We are a small obs unit and do not have the all the resources if someone starts to go down hill -(mind you it is the particular nurse NOT the department that I am upset with).

As for the CT - our protocol is an 18g in the forearm or AC, anywhere basically besides hands, wrists and feet. I was told that it is due to the pressure that the injector requires to inject the dye. They used to accept hands but after a couple of infiltrations in "good" IV sites they have now banned them.

Akteddybear · Jun 20, 2004

In our ER the Xray dept requires an AC Iv for Procedures requiring contrast.So, it is easier to start an AC if the patient c/o chest pain or pulm sx.