IVs in the breast

applesxoranges, BSN, RN · Nov 2, 2015

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.

Flyboy17 · Nov 2, 2015

In my previous years in the ED, infusion centers, Cath and EP Labs I have started my fare share of INTs in the upper breast as well the Deltoid, Scapula area, Side of neck, all kinds of weird places. Just clean it well and stick, if its a good site you will get blood flash just as if you had an INT in a Forearm with a tourniquet.

AnnieOaklyRN, BSN, RN, EMT-P · Nov 2, 2015

If that's all they have maybe a PICC needs to be placed.[/quote']
PICC lines are not meant for emergencies, nor should they be placed for short term IV use. PICC lines take up to a half hour to place!
I would NEVER put an IV in breast tissue, use an EJ or IO if it is an emergency, or a central line!
Annie

AcuteHD · Nov 3, 2015

PICC lines are not appropriate for anyone that has or will likely need an HD AVF/AVG, our nephrologists are very strict about that. Many years ago, as a floor nurse, I had an HD pt that had a PIV placed in her breast.

BumbleBuddy · Nov 3, 2015

Does anyone have any evidence based information on IV access in the breast? I've seen some catheters placed in the breast by nurses in the ED and I'm trying to find Best Practice/Evidence for this.

I'm not sure it's Breast Practice (see what I did there?), but I've seen it a few times, usually on the upper chest. Im curious about the safety of it too. Desperate times call for desperate measures I guess.

VANurse2010 · Nov 3, 2015

PICC lines are not meant for emergencies, nor should they be placed for short term IV use. PICC lines take up to a half hour to place!
I would NEVER put an IV in breast tissue, use an EJ or IO if it is an emergency, or a central line!
Annie

Psst... A central line is going to take just as long if not longer than a PICC.

PMFB-RN, RN · Nov 3, 2015

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.

Well said and so true!

That said I have and will use IVs in the breast for things like the female patient who does not need fluids, but mainly needs doses of IV pain meds and no other access can be obtained. I am not going to IO her so she can get some IV narcs every 4 hours.

~PedsRN~, BSN, RN · Nov 3, 2015

I just keep thinking how jiggly it would be trying to thread the catheter in.

vintagemother, BSN, CNA, LVN, RN · Nov 3, 2015

I just keep thinking how jiggly it would be trying to thread the catheter in.

I'm thinking it's used where the breast tissue is thin, like up high or on smaller breasted persons. But who knows? I should google it! [emoji23]

VANurse2010 · Nov 3, 2015

Well said and so true!
That said I have and will use IVs in the breast for things like the female patient who does not need fluids, but mainly needs doses of IV pain meds and no other access can be obtained. I am not going to IO her so she can get some IV narcs every 4 hours.

Agreed. I don't think IO/CVC would really be appropriate for a dehydrated, hemodynamically stable patient who just needs some crystalloids - assuming they're not being admitted. I would also consider assessing the appropriateness of the foot in some cases.

AnnieOaklyRN, BSN, RN, EMT-P · Nov 3, 2015

Psst... A central line is going to take just as long if not longer than a PICC.

Pssst... not they don't! Apparently you haven't seen an ER physician put in a central line!

Annie

VANurse2010 · Nov 3, 2015

Pssst... not they don't!

Yes, they do, if they're not some non-sterile hack job. I am not going to argue about is, because a lot of it depends on the patient and the person putting it in.