IV policy

Does everyone get an IV where you work? I remember from nursing school my OB instructor saying "Always make sure you have a patent IV" Is this pretty standard or is for only mom's being induced/with epidurals/on mag/needing abx?

Thanks!

Everyone gets one because we have a moronic NPO-during-labor policy. The well educated patients using the midwives are sometimes able to get away with a hep lock and po juice.

Altalorraine

I work trauma/medsurg and everyone has IV access even if it's a heplock. Never know when someone will go bad and you need one immediately.

We use IV's a lot, but there are pt's who are well educated about labor, choose a midwife or MD who is OK with no IV, but everyone is educated about the need for an IV, and the situations that require an IV.

All of our pts get IV access for possible emerg. situations. I have only had a few pt's refuse any IV (heplock) and they have to sign a refusal form stating the risks for complications and releasing liability for any bad outcomes due to refusing.

I work trauma/medsurg and everyone has IV access even if it's a heplock. Never know when someone will go bad and you need one immediately.

Working here it's required too. Even our "well" patients in cardiology have a tendency to go bad fast...and IVs are a necessity for resuscitation. Heplock is the order of the day, right up until discharge.

vamedic4

Smiling in the Texas heat;)

All of our pts get IV access for possible emerg. situations. I have only had a few pt's refuse any IV (heplock) and they have to sign a refusal form stating the risks for complications and releasing liability for any bad outcomes due to refusing.

I'm just curious if you have witnessed any bad outcomes due to refusing? Just wondering how common a problem requiring IV access is.

Here they all need patent IVs. And they all have to be #18g.

MW patients refuse somewhat regularly.

As far as bad outcomes due to a refusal? Well, I work antepartum, so except for my cervidils, they're all high risk. We had one woman, MARGINAL previa. Marginal...borderline not even a previa....Anyway, she'd been with us for about a month and just refused to keep getting stuck every couple of days (saline locks weren't keeping on her, no matter how often we flushed, and the docs wouldn't do a kvo). So she refused.

Thankfully, she bled one night. Just about the size of a deck of cards on her underwear. We saline locked her, and she was fine. The next night (which was Aug 1st btw) she hemorrhaged on our unit. 12th floor. 4 floors away from L&D/the OR. But she had the iv from the night before. She was a pretty easy stick, so we could have easily popped one into her that night, but thank god, it was one less thing to worry about, and one less thing for L&D to run their mouths about.

kelly

Does everyone get an IV where you work? I remember from nursing school my OB instructor saying "Always make sure you have a patent IV" Is this pretty standard or is for only mom's being induced/with epidurals/on mag/needing abx?

Thanks!

Nope. Only pts desiring medicinal pain relief, those on Mag, pitocin, antibiotics, etc. Our low risk pts do not have to have them. It is a rare occurence that an emergency arises where you can't get an IV in quickly.

I understand the just in case rationale, but don't really agree with it. It's kind of like asking if we should have Mity Vacs on every delivery table, or anesthesia awaiting at the bedside for every delivery, just in case, kwim?

All of our pts get IV access for possible emerg. situations. I have only had a few pt's refuse any IV (heplock) and they have to sign a refusal form stating the risks for complications and releasing liability for any bad outcomes due to refusing.

So, help me understand, if a pt refuses an IV, then abrupts with no warning and loses her baby, the hospital is essentially telling her it is her fault because she didn't want an IV? It would be interesting to see hwo many bad outcomes there are just because someone didn't have IV access.

We routinely do IVs for all inpatients and Pit inductions (obviously) and SLs for Cytotec inductions. A laboring mom isn't inpatient until ROM or it's obvious that her cervix is changing and she's in active labor. At that point, she would get the IV placed.

Of course, she always has the right to refuse. We don't have a waiver that we have her sign.

We're supposed to do 18g (which I think is ridiculous when placed in the hand, especially after taking an IV therapy class recently). However, if she requires a few sticks, we have the option of using a 20g unless she's a scheduled section.

With us here, we always keep a patent line. i agree when one said we never know what's gonna happen. And just in case, that's one thing less to worry about.

saline lock in most cases.

IV only if patient plans epidural or is being induced with pitocin.