IV access and scheduled antibiotics

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Pt lost PICC due to thrombosis at 4 pm. New PIV placed 11 pm, infiltrated right away. Pt has been on q 4 hour IV abx. So far missed 4, 8 and now midnight doses. Mom of this patient very angry no IV access established, and charge nurse decided mom is 'abusive' and that this could wait till morning. What is wrong with this scenario?

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Everything lol

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specifically?

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Specializes in Acute Care - Adult, Med Surg, Neuro.

Why did they wait so long to get a new PIV for starters, or why did after the PICC thrombose they get an order for an IJ?

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Specializes in Infusion Nursing, Home Health Infusion.

Is this real life or homework because my answer may be different based upon that?

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real life.

Must add, pt is a hard stick.

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Specializes in ICU.

Ummmm...not something that can wait til the morning. Pt needs a reliable PIV, central line, or new PICC.

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Specializes in Infusion Nursing, Home Health Infusion.

A thrombus in and upper extremity PICC arm is not always an absolute contraindication to leaving the PICC in place I would have to know all the details but many times you can continue to leave the PICC in and treat in place.There are many things going into the decision..is the thrombus occlusive or non-occlusive...is it in the vein that the PICC was placed or a different vein ..if not in the arm is it in a central vein...how symptomatic is the patient.....what are those symptoms.......how long is the prescribed IV therapy need for and what is it...including the ph and osmolality...what is the status of the other arm in case a new PICC is needed and ordered.... so after you gather all that information you make the decision what is best for the patient based upon the risk versus the benefit to the patient . Often this will require and IV specialist to be involved in the assessment and often requires a conversation with the MD or LP.

Many times we leave the PICC in and treat...many times we leave it it overnight and replace it in the other arm in the am so there is no delay in treatment. If the IV therapy is only needed for a short time you could also pull the PICC and complete the course of therapy with the use of PIVs until completed. It all depends upon the individual case and the all important nursing assessment. Too bad the mom got so angry but if she was not refusing the restart I would have tried to calm her down and when things were calmer I would have restated the IV. If you are not great at starting IVs I would have called for the most experienced person...sometimes getting a nurse that the family does not blame (unfounded or bot) really helps to diffuse the stressful situation... Try not to get defensive.stay calm and present the facts. I think sometimes patients and families think we are magicians or something. I do not think they truly appreciate how difficult it can be at times to establish a peripheral IV especially in the pediatric population. I wish I could get some more information about the case and I can tell you the best course of action because you do not always have to immediately pull them.

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PICC was pulled at 4 pm. Mom was upset no one was starting PIV. The one PIV started (@ ~11 pm) had pain/phlebitis right away. Mom was also upset at discovering tournequet accidentally left on for over an hour before discovered (hidden by gown). Patient's nurse told mom no one was avail to start PIV until a.m., so patient did not get abx from 12:00 noon until the next morning at ~09:00.

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Specializes in pediatrics.

Wow this is a horrible scenario, why isn't the doctor addressing this?

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surgeon mostly absent, otherwise covered by moonlighter who covers whole hospital at night.

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Specializes in Infusion Nursing, Home Health Infusion.

I think the mom is justified in being a bit upset. I have written about tourniquet safety on this forum many many times. This is so preventable with good care. I never ever start an IV without unsnapping the gown all the way up or if an OP I insist on taping up the sleeve so the tourniquet is ALWAYS exposed. As a secondary check I run through a safety check when I am done...did I dispose of any sharps safely..is the tourniquet popped and all waste removed...then I check the IV set-up from top of bag down looking for anything amiss. If someone else is starting the IV for you and returning the child back to their safe place then you go in and check since you cannot depend that they removed it.

Next I would get some training on starting PIVs so this does not happen again but as I said unless the pt was very symptomatic and the thrombus was in the arm and non-occlusive the PICC probably could have been left in place for a bit or left in placed and treated . I would need to have all the facts though.

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