IVs in the breast

I don't know about evidence, but I have started a couple that were borderline breast/shoulder and I have seen a coworker start one not too far above a nipple before.

I'd say regardless of safety, if you are that desperate for access, the benefits of having access are going to outweigh whatever problems might occur from said access being in the breast.

If that's all they have, maybe a PICC needs to be placed.

YOWCH!

In the ER there is usually no time for a Picc nurse to be called in, plus these patient that are hard stick are not always admitted. Which means you'll have to dc that Picc line before they go home. Sometimes a central line is too invasive for what is going on with the patient. Where I work most of the paramedic techs and nurses are trained to place sono guided PIVs. I think that's the best option.

I've never put one there or even seen one placed in the breast, but I did an informal poll once with our CRNAs, and all of them had either done one there or seen it done at some point.

SEEMS like there should be better alternatives, but apparently it can be argued to go that route when circumstances dictate.

I would think there would be a lot of options before that- central access, u/s guided PIV, IO, trying to avoid need for IV access at all by utilizing IM and subq routes.

I have seen them done, and have done a couple myself.

As for all the alternatives:

-Multiple people attempted, including the people working that shift who are notorious for getting the tough sticks.

-Ultrasound attempted. No peripheral veins large enough to even handle a 24. No, not even the EJ.

-PICC team doesn't come in at night

-Pt refused central line/doesn't meet criteria for MD to place one

-IO? Really? How are we supposed to get blood from that? Plus, it's very, very painful, and there are some medications that we have that have not been tested for IO administration. Plus all the other issues that come with IO access.

-Pt needs IV fluids. Or IV contrast.

If that's all they have maybe a PICC needs to be placed.[/quote']

That's probably true, but PICCs are not available 24/7 at the vast majority of facilities.

I have never put a PIV in the breast, but I have put some in the shoulder/chest area. I have stuck (successfullly) for labs in the breast.

ETA: I would agree that US-guided PIV is the best option, but US is not some panacea for bad/difficult sticks. Sometimes you can't find anything appropriate with that, either.

Most people say IO is only as painful as an IV, any med that can be given IV can be given IO, and it's far easier to stick a vein for labs than it is for IV access. I would trust an IO site before I would trust an unproven site, surrounded by lymph tissue, like a breast. It's a very underutilized form of access.

I don't have any evidence, just observations. Twice I have seen IV's placed at the breast.

The first time was with a difficult stick patient who needed something IV that I can't remember. Maybe anti hypertensive or antiemetic. She was a dialysis pt with 1 working fistula and another arm totally scarred from previous ones. Bilateral BKA. Multiple attempts for peripheral, not a candidate for central line.

Our policy is we have to call the house supervisor who will attempt or assess and make the call for a sono guided. Sometimes supervisor will get ICU or ED to do sono, otherwise we are waiting on the PICC team which will take literally all shift. Anyway, the house supervisor placed it on her breast. It was strange to see

for sure.

The second time was for a patient who received IV abx in the ED. ED had placed it as a temporary solution, while waiting for PICC team to place a sono or PICC. Once get was done we took out the PIV.

It makes me nervous because of the possibly of tissue damage if an IV infiltrates.

Not to be mean, but a lot of people that do it seem to do it out of "I want to always get an IV" and not "it's best for the patient." We had one in the breast because MD did not want to do a central line and we needed heparin, antibiotics, and mag. We ended up with a 20 in the breast, 18 in the AC, and 22 in the wrist.