IV sites for Abd CT

[Louerrn]

Our radiology dept has started to refuse IV lines, regardless of gauge, for sites below the forearm. They also refuse to take an EJ saying only an IJ is acceptable. I'm curious what the policy is at other hospitals. This seems like bad medicine to me. I am seeing many pt's not being able to get CTs with contrast due to this policy. However, in my 3 yrs of ER nursing, I've NEVER seen an infiltrated line in the hand from CT though I'm sure it happens. I also think the alternative of placing a central line in the IJ just for a CT also seems like bad practice! I have had a CT tech tell me that if my IV was 1 inch higher, she would take it.

[Sassy5d]

That's how it is at my place.

Think of it this way.. Veins in your hand are smaller.. The iv contrast is high pressure. What happens when an iv infiltrates with radioactive dye?

We have special, expensive, 22g high pressure angios for exceptionally hard sticks, but they must still be in the proper location.

Worst case scenario, provider has to insert iv via u/s.

Policies are policies. We have them for a reason. Covers your butt, and it's good for pt safety.

[zmansc, ASN, RN]

For CT angios we have to have 18g or larger in AC. They will take an EJ, as long as it flushes well, but think about it, would you want to have your pt's EJ blown?

For CT w/ contrast they will take any good IV that flushes well.

[Altra, BSN, RN]

EJs have a higher risk of infiltration -- I have not seen a radiology protocol that allowed administration of contrast through an EJ. The tech was simply pointing out that a central line (IJ) would be acceptable, while an EJ would not.

Given the prevalence of griping about the ER tendency to start IVs in the AC or other sites considered not friendly for typical inpatient 72-96-hour use ... I'm going to say that your new radiology protocol is more typical than your former one.

[psu_213, BSN, RN]

Our policy for for CTAs is 20 ga or larger "above the wrist." Over a certain weight, the pt needs an 18 ga or larger. I once had a CT tech try and tell me that a patient (who was not that large) had to have an 18 ga in the right AC (yes, he was that specific on the "required" location).

[Louerrn]

We have the same policy for CTAs and I understand that. I even get rejecting a 22 g in a finger or the inner wrist. What bothers me is seeing multiple pt's get rejected for CTs with great hand veins and an 18g IV. The pt I was referring to in my original post had an 18g in her cephalic vein at the wrist/radius. Flushed like a champ! She was a dialysis pt with a restricted extremity so we had very few options and felt grateful to get the line we had. The EJ was an 18g as well (placed by pt request who was getting upset with the multiple IV attempts). I understand not using an EJ for CTs too but at this point we were completely out of options. This was for CT of the abd not a CTA.

Pt got a CT without contrast which lead to basically an inconclusive CT result, pain 10/10, and told to f/u. I just feel like we failed her because her IV was an inch too low.

[Sun0408, ASN, RN]

#18 or a # 20 in the AC or central line is our only options for CTA's or CT's with contrast.

[Gabby-RN]

20G or bigger above the wrist is my hospital's policy.

[turnforthenurse, MSN, NP]

For CT PEs the site must be in the forearm or higher. They prefer to have it in the AC and it was to be a 20G or larger. The contrast infuses at a higher rate for CT PEs than other CTs with contrast hence the need for a larger IV site in a larger vein.

For other CTs, they will accept a 22G but they cannot do them with a 24G. Our tech have done other CTs with contrast in the hand. They won't do EJ sites though.

[psu_213, BSN, RN]

What bothers me is seeing multiple pt's get rejected for CTs with great hand veins and an 18g IV. The pt I was referring to in my original post had an 18g in her cephalic vein at the wrist/radius. Flushed like a champ!

I have had patients that have had IVs that flush well and give great blood return. They come back from CT with ice packs on their arm and the tech tells me "the IV blew while the contrast was going it. The policies are not made to be a pain in the rear for nurses (even if the opposite seems true).

[psu_213, BSN, RN]

Pt got a CT without contrast which lead to basically an inconclusive CT result, pain 10/10, and told to f/u. I just feel like we failed her because her IV was an inch too low.

I think this is being a bit dramatic. If they had used contrast would that have led to better control the pain? Obviously her pain was not treated well, which is totally unrelated to the use of contrast for the CT. Also, if she is told to f/u that is on the doctor. Obviously he/she felt comfortable with the non-con study. As a patient advocate, you should approach the doctor asking if more diagnostic testing should be done. You should advocate for better pain control. However, at the end of the day, it's the doctor's call if the CT was adequate for a safe discharge.

[emtb2rn, BSN, RN, EMT-B]

Same as gabby.