IV in Emergency?

[CEG]

Just curious after the patient's preferences thread. How many of you have actually had an emergency where you used an IV? I mean a no kidding, seconds matter, couldn't get one in, need the IV to save someone's life. Not during a surgery or really on a patient with an epidural, just a normal low-risk woman with no interventions. Just wondering how many have really experienced this. Thanks.

ETA: In LABORING women....

[HappyNurse2005, RN]

Personally, no, i haven't had a low risk woman wihtout an iv who then needed an iv in a life saving emergency.

as someone else said, ther eis always im/pr meds for pph, docs/anesthesia who can do a central line if necessary, and MOST women who are low risk don't need an iv and would be fine without them.

[Spidey's mom, ADN, BSN, RN]

The original post is a bit confusing . . .but I'll go with what the rest of you are talking about.

I have had emergencies come up in deliveries when the patient did not have IV access. Usually post-partum hemorrhage. And I've gotten an IV in quickly, started fluids, called for extra help.

I too think having an IV in place feels better. I always try to prepare ahead of time for all emergencies. But we don't always put a saline lock in place. Many women just don't want that kind of "intervention".

steph

[Spidey's mom, ADN, BSN, RN]

Personally, a little bit of adrenaline guarantees I get the IV in the first try!

I find the same thing -

steph

[eden]

I've had to start one a few times in an emergency. There is almost always someone nearby and we have a great emergency system that help is pretty much instantaneous. If I don't have an IV and I can't find a vein, ACF is pretty much a guarantee. I know it can be an annoying spot and be positional but by the time an IV is REALLY needed, the patient is not objecting to where we are placing her IV. Yeah it's great to have an IV in place but they are not a necessity with all labouring women and in my experience not having an IV has not made a difference in our response time. If someone is at high risk for a PPH, they have a running IV or at the very least a IV to lok.

[queenjean]

I worked (well, continue to do prn) in an out of hospital birth center for several years. We requested IV access only under certain parameters; so probably only about 25% of our moms had a lock.

Only once in maybe 200 or so births where the mom didn't have access did I need to start an IV in an emergent situation. And I got it in first shot--no kidding about the adrenaline. Yes, it would have been easier having it in. Every mom who walks in the door has that option. But we dealt with it and it worked. It delayed fluids by maybe 2 minutes to not have the access and the fluids already running; I'd already injected the pit IM.

Every other time we've had "an emergency" we either anticpated it and inserted a lock, or we dealt with it without needing immedicate IV access. I feel comfortable having low risk moms not have IV access. I won't hesitate to request to insert one if I have a bad feeling about how things are going.

[Elvish, BSN, DNP, RN, NP]

You bring up an important point, queenjean, about trusting your instincts. They are there for a reason, and if your instincts tell you to start a lock, you'd do well to at least consider it. But if not.....:)

[Lindz]

I'm due in May. I'd really rather not be that one in a million obestrical emergency. I also don't want to be tethered down. I'm more than happy to compromise with a SL. I know I'm relatively low risk (VBAC), but I also know how in any area of nursing things can go really bad really fast. Kind of the same reason I won't take out my patients' IVs until I'm ready to go over the dc info. Do I need it, not really, but why mess around?

[RNmama05]

Do I need it, not really, but why mess around?

Choosing NOT to have an unnecessary invasive procedure is not "messing around". Everyone has different levels of risk tolerance. (How many of us know what our risk of death is from a traffic accident every time we get in the car). Human beings are notoriously poor at assessing true risk; we tend to assign low risk to familiar things like getting in the car, and high risk to unfamiliar things like childbirth without an IV.

[CEG]

Thanks for all the responses. I am new to nursing yet, but I know how having a saline lock was very agitating to me in labor trying to move around/ get comfortable and not bang the thing around. Just curious how often this precaution was actually used and everyone's perceptions.

[RNLaborNurse4U]

I opted for no heplock for my 3rd delivery (100% natural), even with gestational hypertension that I had with that pregnancy. I weighed all of the options, and decided that I would go with the no heplock based on my good pregnancy/labor history, and wanting to do it without being tethered to medical devices this time.

I also declined routine IM pit after delivery, since my bleeding was normal.

[Belinda-wales, RN]

This has turned out to be a chat I have enjoyed following it - just last night a new nurse came to me that a mom did not want an iv she was low risk -I supported the nurse and reasured her mom went on to have the birth she wanted not in bed and legs in poles - the mom was delighted with HER experience and the nurse was blown away this was her first experience of a women centered normal birth -next patient through the door was a sucessful vbac - what a great night.

[siggie13]

Let me add my two cents to IVs in general. There was once a time when I actually had patients in the hospital who were up walking, eating, and probably would have done better at home. Now, all of my patients need to be in the hospital and all have the potential of suddenly going bad. I want all my patients to have some kind of IV access just in case. Call me overly cautious but I have had too many crashes of patients where we were rushing to get an IV in and not always successfully. I think those of us who work in hospitals have long passed the point where we have easy patients. The one place we need to be overly cautious is the hospital.