IVs in the breast

nursephillyphil, BSN, RN · Nov 3, 2015

I don't think it would have been a vesicant. We are extremely hesitant when any kind of chemo goes through a peripheral line, having one in the breast? I would refuse and ask for a picc or a central. Besides, patients will go through multiple rounds of chemo, they'd need one eventually.

Anna Flaxis, BSN, RN · 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.

Good luck. As far as I am aware, there is no evidence to support this practice, and the risks outweigh any potential benefit. In my opinion, this practice should be discouraged.

PMFB-RN, RN · Nov 3, 2015

A lady had a IV in her breast at my hospital. The IV extravasated and she ended up losing her breast.
No thanks!

She didn't lose it from NS or IV morphine. Who would run anything else in such an IV I can't imagine.

calivianya, BSN, RN · Nov 3, 2015

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.

So true. It can definitely take half an hour when some of our reluctant physicians who like to sleep in the on call room and order PICCs place one, but we've got one young rockstar pulmonologist in our intensivist group who loves getting his hands dirty and does procedures all night long when he's on. That man can get perfectly sterile, place the line, suture it in, and dress it in less than five minutes. Wish I could work every shift with him because he gets things done.

She didn't lose it from NS or IV morphine. Who would run anything else in such an IV I can't imagine.

I have. Dialysis patient, nothing at all on the arm we could use, even with u/s, nothing we could stick on her feet, either. She was severely septic and her pressure was in the 60s/30s range, if I remember correctly. I ran Levophed and some abx through a 22 in her breast. This was at a previous job - a community hospital where we had no intensivists, no PICC team at night, and the hospitalists usually refused to drop lines. I don't even think we had an IO kit in the unit. We eventually managed to convince the ER physician to come up and stick a line in her, but not before she went hours with some of the worst possible vesicants infusing through her breast. Her breast ended up okay, as far as I know. It didn't infiltrate for us.

Bob Loblaw · Nov 3, 2015

Each circumstance is different. If needed quick, ED doc will go EJ. I've seen paramedics also use this route in the field but outside of my facility RN scope of practice.

I agree with someone further up the thread about IO's- seems to be a reluctance to ever use them, although I've only done 1 seemed quick and easy, now there is a site in humeral head. Watched vendor movie with cadaver about flow from there to subclavian vein, nearly instantaneous.

nrsang97, BSN, RN · Nov 3, 2015

I have only seen 2 IV in the breast. They were used short term, and no issues, however, this is not a site I am willing to use on a routine basis. At night being the only rapid response nurse to help with difficult IV access, and the house physician not willing to drop an EJ, and that being out of my scope surely makes things difficult. We do not have access or training (yet) for the ultrasound machine, or to place an EJ (possibility of us being trained), nor we do not have ready access to IO kits either. We have only used one during a code. If asked to place an IO, I would have no idea where to find a kit.

Surgical residents give grief when a patient truly needs a central line at times, we have no PICC nurse on at night, and anesthesia cannot always help either since they are in a c-section or placing an epidural. ER will not come to the floor to place lines. One night we had to have anesthesia place a central line in a patient because we had no surgical resident on that night.

I agree that IO is very under utilized for access in difficult situations.

certjunkie87 · Nov 3, 2015

I've placed multiple breast IVs in the ER. We don't always have time for a sono guided IV and for drug users it might be just enough to give the meds and get them home. I don't use the breast if the patient needs pressors, K+, ect. But I've given lots of meds through breast IVs and I've never had a problem.

Patients also say they hurt less than someone digging around in their arm.

imintrouble, BSN, RN · Nov 3, 2015

Upper arm/shoulder/upper chest is the closest we get. It's just unspoken that we don't go there.

What happens in the ER stays in the ER. I'm sure they have to make tough choices about IV placement.

Up on med/surg circumstances are different.

Julius Seizure · Nov 3, 2015

The most impressive PIV that I've ever seen was when my charge nurse placed an IV in the back of the knee on a 3 year old (unresponsive) patient.

Julius Seizure · Nov 3, 2015

I would rather have an IV started in my breast than in my foot. Those foot ones hurt!

Great thread. Can we talk about starting IVs in memberes next?

Bob Loblaw · Nov 3, 2015

IV drug users will thank you after you show them chest/breast veins- its a nice touch. I've done a butterfly in a scalp vein just to get things going. Some have em, some dont. you know those people that have veins popping on their forehead when they get mad.

Jensmom7, BSN, RN · Nov 3, 2015

I would rather have an IV started in my breast than in my foot. Those foot ones hurt!
Great thread. Can we talk about starting IVs in memberes next?

I wondered when someone was going to bring that up! Never saw an IV there, but many years ago an IV drug user told me they're very easy to access.