IV placement in stroke patient?

[Finallydidit]

Okay here goes... I have always been taught not to use the paralyzed limb to start an IV on a stroke patient. My supervisor has been taught the same thing. Other nurses in our facility however, say that it is acceptable.

Whats the real deal?

Thanks in advance

[ChristineN, BSN, RN]

On the stroke unit I work we start them on the affected extremity. What would be the rationale for avoiding the affected limb?

[NYnurseatheart]

In answer to your question I would say it depends. If the patient is in the ER, we simply put in the fastest IV we can to get the blood drawn and then take them to CT - usually no regard for whether it is the affected side or not. If they have good veins (which are few and far between on stroke patients) and have not already been started in the field, then I pick the unaffected side.

[Finallydidit]

The rationale that I was told back when I was becoming a medic, was pain related. As in patient not being able to identify pain is an issue arises with the site. (So therefore avoid if possible) My supervisor said she was taught that it was due to higher risk of thrombosis, because the limb doesn't move.

Thanks for the replies

[ChristineN, BSN, RN]

The rationale that I was told back when I was becoming a medic, was pain related. As in patient not being able to identify pain is an issue arises with the site. (So therefore avoid if possible) My supervisor said she was taught that it was due to higher risk of thrombosis, because the limb doesn't move.

Thanks for the replies

But using that rationale where would you put a PIV in a quadraplegic? Most of my quad or para pts love getting PIV's in areas they can't feel.

[rn/writer, RN]

The rationale that I was told back when I was becoming a medic, was pain related. As in patient not being able to identify pain is an issue arises with the site. (So therefore avoid if possible) My supervisor said she was taught that it was due to higher risk of thrombosis, because the limb doesn't move.

The lack of feeling can be addressed by meticulous and aggressive visual assessment and palpation.

And good and frequent range-of-motion can reduce the risk of thrombosis.

Imagine lying in a bed scared to pieces because you can't feel or move your left side. Now add an IV on your good side that further reduces your mobility. Nothing like feeling trapped in a hospital bed to help you calm down.

[Asystole RN]

The rationale that I was told back when I was becoming a medic, was pain related. As in patient not being able to identify pain is an issue arises with the site. (So therefore avoid if possible) My supervisor said she was taught that it was due to higher risk of thrombosis, because the limb doesn't move.

Thanks for the replies

I would agree with the rationales. Pain is often the 1st symptom of an issue. Relying upon palpation and visual assessment can work with some patients but very difficult with many. Using the unaffected arm is the 1st choice but not the last and only...

It is not a strict policy at my facility but a general rule of thumb. We have to weigh the risk factors with the patient comfort and mobilty issues.

If we are forced to use the affected side we generally attempt to have a central or midline placed to avoid any issues in the first place.

[nurse2033, MSN, RN]

Yeah, what finallydidit said, the patient wouldn't be able to sense pain from a complication. However, I would do it in a heartbeat if I thought it was necessary. That would qualify as a relative contraindication.

[Finallydidit]

Thanks for all the replies guys.... Up until last night have never had the need to use the affected limb, was always able to gain access it the other, so never really gave it much thought. I didn't have orders stating that it couldn't be used, so I used it, because the patient needed the fluids. But I wanted to come on here and find out the deal... So bunches of thank yous to all who answered...