IV Questions from a New Nurse

[BowHunterRN]

I'm a new nurse and have some questions about using IV's. We were taught NOTHING about IV's in school, and it seems like at work everyone just assumes I know all about them. So here it is:

When a patient states that their IV is "hurting" should you not use it? I know some medications burn, like phenergan, but I don't want to use an IV that is possibly infiltrated.

Another question - My preceptor and I had a patient who had a peripheral IV and said it was hurting. It was due to be rotated the next day, so I was just going to change it. My preceptor went ahead and used it. The next week, the patient was back with cellulitis in the same place that the IV was. So, did my preceptor use an infected site?

What is the best thing to do when an IV infiltrates? Ice? Elevate? My preceptor didn't do anything on one patient. And, are you supposed to try to restart the IV in the opposite arm? This patient had an IV in their hand that infiltrated, and it was restarted on the same arm in her AC. If it's above the infiltrated site, that's ok, right?

And - This is more of a med question, but - why is it that some nurses give IV phenergan and dilaudid close together, but others wait an hour? I've looked in books to see why they should be an hour apart, but haven't found an exact answer. Just wondering about this for patient safety.

I feel like I don't know the signs that an IV should possibly be restarted, so I've been trying to read up on it. But I still had some questions, so I thought I'd come here. I hope I don't come off as a clueless nurse, I just want to know more than I do. Thank you so much!!

[Asystole RN]

I'm a new nurse having serious questions about how to take care of patients with IV sites that are obviously infiltrated. A pt pulled her IV out of her hand because it must have been hurting her (she can't communicate very well and has alzheimer's). Her hand was bruised badly and she had a few areas that felt squishy. The pt needed her hand treated and I don't know how to do it. Gosh, any information you can give me is great! I need to learn so I can treat it on my own the next time. What do you do for bruising? Thank you so much for your help. Also, I would LOVE to have the list of meds that are caustic.

I suddenly wanted to give your preceptor a hug.

Is the site warm and inflamed or simply bruised and squishy? Is the squishy from phlebitis or from infiltration of NS? The most important question, what was infusing at the time? If you were infusing a vessicant then you might worry a bit more than if you were infusing NS/KVO. The bruising is not the same type of bruise that you get from an impact or tissue trauma. This type of bruise is from blood simply leaking under the skin, this is a great time to learn to spot the difference.

From what you have described I would have recommended the intervention of raising the patients hand on a pillow and simply monitoring the hand.

"Relax, sometimes the best intervention is the one where you simply do nothing." - My Preceptor many moons ago.

[Asystole RN]

thanks for the list to both of you!

i just thought of another question if you don't mind..

is it ok to take blood from a peripheral IV? I know when first inserted that is done, but what about after a day or two? I always thought that if it wasn't brand new, or if meds have already gone through, you shouldn't take blood from it. But I've seen people try to see if they get a blood return from an IV that wasn't new, and if they did, use it for a blood draw. I just was wondering if this is ok. Thanks.

I am sure it has been far too long to answer you question for your sake but for others reading...

Being able to draw blood more than a few hours after placement of a PIV is a rare thing...unless you are using a larger gauge catheter in a larger vein of course. Drawing blood from a PIV after it has been placed for a little while is a great way to lose your PIV, if you have a second PIV or it is time for changing anyways then go for it, save the pt a stick.

As always though, follow facility policy.

[seekingedu]

Thank you for the explanation about how to assess bruising from infiltration vs something else. Sometimes, it's as easy as explaining the reason for inaction, which you did and I appreciate that. Frankly, being a new grad has a tendency to shoot your nerves all the way to the moon and back. Thank you again, and I will gladly settle down a little (okay, a lot!). :-)

[jolpn]

How did you learn those long lists, or do you rely on a posted list, or a website. Help

[carolmaccas66, BSN, RN]

You can always flush the cannula with 5mls NS to see if it is infiltrated. But if it's red, swollen, looks like it's leaking & really hurts, the IV site is stuffed and the vein will be irritated (phlebitis) swollen & inflamed, (that's why it hurts).

I'd start a new one on the other side, but yeh don't use the AC - people ALWAYS bend their arm and then the plastic cannula gets bent & blocked & won't work. And ur pump will be beeping non-stop and it will drive you up the wall.

The other questions I can't answer cos I don't work in the states.

[DixieRedHead, ASN, RN]

Wow, such wealths of information. How about a short list?

If it runs and it's in date leave it alone unless it hurts.

If it hurts, change it.

Same arm above the site, OK, or the other arm.

Read the drug book to see what's compatible. (You will be glad, and will learn some)

Put phenergan in a 25 cc bag of NS.

If it's swollen,ice and elevate.

LOLs pull out their IVs for a million reasons.

NS only with blood, cause that's the way it is.

That's enough for today.

[Wounderful]

I know this post is old, I'm curious if you could send me the list also ?