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Discussion

IV

Totally feel stupid for asking this but.. If a patient has phlebitis or mild infiltration around an IV site, I know we should d/c the IV. However, I was wondering if we need a new order from an MD to relocate the IV to another site. Thanks!

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    No, nursing judgment. Physicians prescribe fluids, RNs determine site and device (except so far PICC still requires a prescription).

    BANISH the word "orders" from your nursing vocabulary. See the opening editorial in this month's AJN for a wonderful essay on why this archaicism is well-past its expiration date.

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    If it was obvious that the patient still needed an IV, I never once consulted an MD before placing a new one. If it was a post-op baby who was probably going home the next day and was taking all pain meds PO and full PO feeds and we weren't using the IV he had anyway (in kids we tend to just leave them in until they fail just in case), I probably wouldn't even consult the MD before deciding that it didn't need to be replaced.

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    The original order for the line persists so if one craps out, start a new one. No need to consult the doc.

    In the ED, we routinely start 2nd, 3rd, and sometimes 4th lines without ever getting orders for them... nursing judgment. Even when the doc mandates additional lines, it's never codified in writing/typing.

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