Jump to content

IV Rules at your Facility

Nurses   (2,714 Views 18 Comments)

applesxoranges is a BSN, RN and specializes in ER.

15,377 Profile Views; 2,240 Posts

I work in several ERs and it seems like every hospital has different rules when it comes to IVs.

One facility is super strict about placement of IVs for contrast. Can't be in the lower forearm or too close to the shoulder. Must be a 20. The other facilities use the same rule due to being part of the system but they don't follow it.

EMS starts need to be changed within 24 hours. After 96 hours, the site needs to be changed.

Other facility now has a new rule that sites need to be assessed every shift and changed when they look bad. No time frame anymore including EMS starts. However, IVs are not to be started in the wrist or AC because it will make IV pumps beep. No IVs in the upper arm. The person was unable to answer my question regarding CTAs where the current policies of the CTAs prefer IVs in the AC.

Share this post


Link to post
Share on other sites

mmc51264 has 7 years experience as a ADN, BSN, MSN, RN and specializes in orthopedic; Informatics, diabetes.

2,744 Posts; 38,901 Profile Views

CT needs >20 forearm or higher. IV from EMS/OSH have to be changed within 24 hours. Central lines have to be verified by x-ray before use. We leave our IVs in until they go bad (there is some discussion about changing after 7 days). I work on a floor where most pts are relatively short stays (

Share this post


Link to post
Share on other sites

CelticGoddess has 6 years experience as a BSN, RN and specializes in Palliative, Onc, Med-Surg, Home Hospice.

1 Follower; 890 Posts; 11,444 Profile Views

The big reason why they prefer a 20 (or a 16, 18) is because when they do a PE, the contrast is being injected at a very high rate os speed. (My husband actually prefers a power picc or a power port.) If the IV is in the hand , lower forearm or upper arm, there is an increased risk of the IV blowing. Then the ordering physician has a fit, call my husband and yells at him. Then my husband call me and complains because we KNEW it needed to be an AC.

Seriously, the Tech will call us and tell us to bring our sorry selves down to Radiology to re-start an IV if it isn't in the AC. The CelticDude has worked for 4 facilities in the past 24 years and they all had the same policy: must be an AC if they are getting contrast.

As for the rest: We are supposed to rotate every 72 hours but if IV is patent we get an MD order to keep. And if the patient is on an IV vesicant, we are supposed to get a new IV in the forearm or, if patient will be on the vesicant for longer than 24 hours, ask MD to think about ordering a PICC.

Share this post


Link to post
Share on other sites

IVRUS has 32 years experience as a BSN, RN and specializes in Vascular Access.

1,026 Posts; 20,483 Profile Views

The big reason why they prefer a 20 (or a 16, 18) is because when they do a PE, the contrast is being injected at a very high rate os speed. (My husband actually prefers a power picc or a power port.) If the IV is in the hand , lower forearm or upper arm, there is an increased risk of the IV blowing. Then the ordering physician has a fit, call my husband and yells at him. Then my husband call me and complains because we KNEW it needed to be an AC.

Seriously, the Tech will call us and tell us to bring our sorry selves down to Radiology to re-start an IV if it isn't in the AC. The CelticDude has worked for 4 facilities in the past 24 years and they all had the same policy: must be an AC if they are getting contrast.

As for the rest: We are supposed to rotate every 72 hours but if IV is patent we get an MD order to keep. And if the patient is on an IV vesicant, we are supposed to get a new IV in the forearm or, if patient will be on the vesicant for longer than 24 hours, ask MD to think about ordering a PICC.

I am at a loss as to why, anyone would want an IV catheter, which is placed in LESS THAN DESIRABLE conditions/situations like in the ER or out in the field, say by a paramedic, would leave that IV catheter in, just because it is working. IMO, these IV catheters were placed in a hurry, are utilizing less than appropriate cleansing, care as the purpose is so different in an emergency situation. Therefore, leaving these in is setting is the patient up for all sorts of complications.

Share this post


Link to post
Share on other sites

ohiobobcat specializes in ED, School Nurse.

870 Posts; 13,706 Profile Views

I can't speak for EMS, but when I started IVs in the when I worked in the ER, I used the same technique and supplies I used while working on any other unit in the hospital.

Where I worked, 18 g in the AC was preferred for IV contrast. They would take a 20 g in the AC, but I'd get the side-eye. If I had any even passing thought that contrast might be needed for a patient, I would go right for the 18g in the AC. It sucked as far as patient positioning and pumps beeping, but sometimes it was nice to have a large bore IV already in place in a nice big vein if my patient decided to crump on me.

Share this post


Link to post
Share on other sites

blondy2061h has 15 years experience as a MSN, RN and specializes in Oncology.

1 Article; 4,094 Posts; 37,712 Profile Views

We no longer have mandatory time frames for changing IVs. Patency and surrounding skin are accessed q12h at a minimum and the IV is changed when needed. Caps are changed q96h.

Share this post


Link to post
Share on other sites

xaxxax specializes in CMICU.

40 Posts; 1,512 Profile Views

Ems starts must be changed within 24 hrs at my facility, lines must be assessed for patency and blood return q12 and changed if they look bad. >20 for contrast and forearm or above, AC preferred. Most of my patients have centrals in the unit. Then it becomes more of a dressing assessment/cap change scenario with flush protocol. Also we try to get the lines out asap to decrease clabsi risk. We tend to keep CVCs as long as needed unless they are in the groin (change to IJ or subclavian) but temporary dialysis caths need to be out within 10 days or we start looking at a tunneled line.

Share this post


Link to post
Share on other sites

iluvivt has 32 years experience as a BSN, RN and specializes in Infusion Nursing, Home Health Infusion.

2,728 Posts; 24,725 Profile Views

I can tell you what the current standards are and why that is so.Each institutions can choose their own policies as long as they are not below the standard of care. The American College of Radiology syates that for a CT scan the PIV (if that is the VAD being used) must be on a large vein in the mid FA or above.It does NOT state it must be in the ACF to power inject.Many clinicians get confused about this.They ask for the ACF thinking that it is a sure thing bc it is latge and can tolerate a power injection.This is not always the case.Apower injection is a very rapid injection of contrast,which is a vesicant with the ionic type being worse,as high as 8 ml per second. Most do not go above 5 mls per second and it all depends on the type of CT and how large the pt is so good images can be obtained.The most important thing is to get a good and large vein at mid FA or above. There is a special catheter called the Diffusics that works very well as is desgned for power injections.You can use their 22 gauge and I believe it goes as high as 6.5 ml per second if I remember correctly. It has 3 opening so the pressure at the distal end is divided and much less chance of the catheter backing out and extravasating.More info to come bc I am using my phone

Share this post


Link to post
Share on other sites

iluvivt has 32 years experience as a BSN, RN and specializes in Infusion Nursing, Home Health Infusion.

2,728 Posts; 24,725 Profile Views

As far as periphersl site rotation goes...this is no longer recommened if the site is asymptomatic.Site rotation should be based upon assessment. The trend now is towards venous preservation and it has been found we were doing more damage by routinely restarting perfectly good PIVS .This makes it important to know how long your site has been in place as part of your assessment bc generally the older it is the higher the liklihood of it leaking or infiltrating or other complcations.INS has a white paper on this thaIcsn link if anyone is interested.It goes in great detail.

Share this post


Link to post
Share on other sites

iluvivt has 32 years experience as a BSN, RN and specializes in Infusion Nursing, Home Health Infusion.

2,728 Posts; 24,725 Profile Views

I have the max mls per second that can be given with each gauge if anyone is intetrsted

Share this post


Link to post
Share on other sites

IVRUS has 32 years experience as a BSN, RN and specializes in Vascular Access.

1,026 Posts; 20,483 Profile Views

As far as periphersl site rotation goes...this is no longer recommened if the site is asymptomatic.Site rotation should be based upon assessment. The trend now is towards venous preservation and it has been found we were doing more damage by routinely restarting perfectly good PIVS .This makes it important to know how long your site has been in place as part of your assessment bc generally the older it is the higher the liklihood of it leaking or infiltrating or other complcations.INS has a white paper on this thaIcsn link if anyone is interested.It goes in great detail.

Yes ILUVIVT, I agree with this new recommendation for IV catheters put in in the right way: Proper cleansing and care with insertion, and not a quick swipe as EMT's will do in an emergency. I wouldn't want that IV catheter left in me until it went bad... But I would want it to dwell in situ, if they took their time, and did the procedure appropriately.

Share this post


Link to post
Share on other sites

123 Posts; 3,934 Profile Views

Any patient going for a test with contrast needs to have a 20 or larger in the AC. We used to have to change out IVs after 96 hours but that policy has now changed and we can keep them in as long as they are still patent. As an inpatient nurse, I frequently move the IVs to a different location when the patient gets admitted from the ED because of the constant beeping that occurs if the line is in the AC. Also, we need an order to put an IV in the foot

Share this post


Link to post
Share on other sites
×