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.

[BrooklynRN11201]

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.

I 100% agree with this - it's the same at my hospital and I don't see what the big deal is. The provider wants IV contrast for a hard stick? Get the ultrasound and do it yourself - I'm not compromising my pt's safety with your "can't you get a 20g in the hand and just see if they accept the pt?"

[TeresaHolloway]

Our radiology insists on 18g right ACF for CT PE study...Usually as long as there is a 20g they are happy...They can't use central lines...

[ChristineN, BSN, RN]

Our radiology insists on 18g right ACF for CT PE study...Usually as long as there is a 20g they are happy...They can't use central lines...

Why on earth does R AC vs L AC matter? What if the pt has a R arm AV fistula or R arm precautions from a past mastectomy?

One of my peeves is "xx or larger"

If xx is big enough, then forget "larger". The larger the needle and catheter, the more scarring and irritation to the vein.

Start what you need and forget "or larger"

[Racer15, BSN, RN]

Wherever I put the IV. I have never had CT gripe at me for a 20 in the hand. I place my IVs where I can and I avoid the AC when possible in case they are admitted. Never been an issue.

[canoehead, BSN, RN]

We're very lucky in that if we can't get the 20G AC we never hear a peep about it, the tech or the radiologist use an ultrasound to get the access they need.

[thelema13]

20g for CT's, but some techs will use 22g. CTA's are 20g AC or higher, preferable R AC. Per policy.

[Ciale]

I thought it had less to do with blowing a vein than it did the speed at which they have to push the dye in order to get a quality picture. Like, they can use a 22 but its not gonna be a great quality CT?! And, that would be really unfortunate for the patient and kind of a waste of money for an expensive scan. ??

[tech1000]

CT chest angio is a 20g a above the mid FA. CT angio of the brain has to be right sided also. Any other CT with contrast can be done with a 22 in the hand. If they have to manually inject the contrast, they can do it. Ain't nobody got time to be busting out an US machine to place a 20ga in the AC of some of these people. Let's be real.

[psu_213, BSN, RN]

CT angio of the brain has to be right sided also.

But why specifically on the right side? I, personally can't think of a good reason…am I missing something?

[tech1000]

I'm not sure where my answer that I typed just went. I meant left sided. CT said because it travels to the brain faster and they need to contrast to get into the brain as fast as possible. I don't know if this is actually accurate or if this is CT's policy just because nobody has questioned the effectiveness before of a right sided IV site for CTAs of the brain.

[psu_213, BSN, RN]

I don't know if this is actually accurate or if this is CT's policy just because nobody has questioned the effectiveness before of a right sided IV site for CTAs of the brain.

I'm guessing it's because nobody questioned it. I have seen may scans of the head with contrast done with a right sided IV and it has turned out just fine.