IV Rules at your Facility

[applesxoranges]

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.

[hawaiicarl, BSN, RN]

I recently did an EBP search on this for an inservice, and the results surprised me. Current CDC, AACN and SHEA recommendations no longer have a time frame for removing lines placed under sterile conditions. Lines placed emergently should be changed within 48 hours according to the guidelines. This is for central lines not peripherals, but shows how recent research is changing practice.

Cheers

[Lev, MSN, RN, NP]

A 20g+ IV in the AC, upper arm, or shoulder is required for Chest CT to rule out PE. For other CTs that need contrast any gauge well functioning (able to aspirate blood) IV can be used at my facility. You can give contrast through a 24g IV.

Femoral lines have to be changed out ASAP.

[iluvivt, BSN, RN]

Yrs IVRUS I was referring to IV sites placed using a good and solid technique.We resite field starts ASAP. Unfortunately the recent peripheral infections I have seen have come from our own ED and I suspect it's from quick swipe of alcohol instead of a CHG prep.

[applesxoranges, BSN, RN]

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.

Well, a lot of ambulances now utilize the same kits in the ER. In fact, some stock themselves from ERs. Most IV starts in the ER or EMS are not emergent. I will start IVs in the ambulance to give someone zofran so I don't have to deal with them puking.

I didn't realize how common it was not to change sites. I love hearing about different facilities because I work in several different ones. It is entertaining to see how different each facilities are.

[akulahawkRN, ADN, RN, EMT-P]

When I worked as a Paramedic, I used exactly the same technique for starting PIVs in the field as I did in the ED while learning the skill. Back then, nearly all IV starts used alcohol swabs. Now nearly everyone that I'm aware of uses CHG based preps that are included in start kits.

I did some looking into the practice of changing out field start IV lines and it appears that the primary reason these lines are changed out within 24 hours is that the hospital cannot say these were done properly (even if they were and the site has no sign of infection) and the hospital (usually) cannot set PIV start standards for EMS crews and because of that, field PIVs must be removed within 24 hours.

[Ellie G]

EMS starts changed in 24 hours. Contrast at least a 20g from mid forearm to mid upper arm. Dr order for "alternate sites" i.e. Foot, leg, shoulder or chest. All peripheral IVs 4 days maximum dwell. Personally if I'm down to alternate sites, or finger, thumb, or inner wrist or the pt needs more than 2 peripherals then I'm calling for a picc or central.