IVs in the breast

Nurses General Nursing

Published

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.

Specializes in Hospice.
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.

Used to do them in kids all the time.

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

I've never seen one started in the breast. Lots in the foot though. That's usually where I go when I can't find another place.

We are a rural area - our PICC lines had to depend on the CRNA. If he was in surgery, he was busy. If he was home and on call, it took about 30 minutes before he could get there.

I always set up for him - so the actual act took about 5 to 10 minutes.

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Rarely possible to get PICC placed in ED. Generally, mess needs to be started, you place whatever IV you can get, and then the PICC placed whenever they can fit it in. Where I work (and it is a large hospital) there is one full-time and one part-time PICC nurses who work 8-4:30. (I want those hours!)

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Specializes in Acute Care Pediatrics.

The thought of vancomycin running into my breast just made me dry heave.

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Specializes in Family practice, emergency.

Ever heard the phrase "any port in a storm?"

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I had a young lady come in stating she was in SCC pain. She pretty much had no access, but pointed to a crooked, thin blue vein in her Rt breast. She then said this is where they put them at XXX hospital, which was really only a stones throw from our hosp. Well, I told her that I could not in good conscious place an IV there, but I was willing to look elsewhere. I got a 22G in her thumb right above the knuckle. And do you know, she was irate that placement was successful, and went AMA after she was told that her Dilaudid 4mg Q 1 hour is not this ERs practice for management of crisis pain. Go figure.

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...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.

Why not use her dialysis access? Seems appropriate for the situation to me. Unless she was a PD pt, of course.

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Why not use her dialysis access? Seems appropriate for the situation to me. Unless she was a PD pt, of course.

If we're talking about permanent access like a tunneled catheter, facility policies often preclude nurses who don't work in dialysis from accessing them (as I'm sure you're aware) and there isn't always a dialysis nurse available. However, I have worked in a facility where the nursing supervisor was authorized to access them because there was no 24/7 dialysis nurse. I'm not saying these policies are good or in the best interest of the patient, but that's how it rolls sometimes.

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

or an IO???

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Specializes in Emergency.

IOs are not painful. The pop is a little disconcerting, but it really hurts about as much or less than an IV. I let a friend do one on me in school. The flush can be painful though. There is one drug that I know of that is contraindicated for IO use--d50. I am not 100% sure but I think it is because it can have necrotic effects when used IO....similar to what would happen if it were administered to a non patent PIV site.

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Specializes in Infusion Nursing, Home Health Infusion.

NO NO and No,Never do this, there is no research to support this practice and it is not recognized by any professional organization. With that being the case should any adverse outcome occur and the patient suffer any damages you as the nurse would not have a leg to stand on legally,even if you had an MD order! Why risk harm to the patient and your ability to earn an income..just do not do it. They will get a Vascular Access Specialist on the stand and they will drag out the INS standards and other industry standards and you will be toast!

If you need access desperately you need to place an IO,then work on getting another type of access. IO can be placed within minutes! Any port in a storm is not true because when the storm subsides and there is an extravasation of Calcium or Dopamine and the patient loses their breast and is disfigured you will be sorry

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Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
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.

I just remembered, the lady I started the breast IV on actually suggested it since we could not find a vein. In reference to member IV's, never started an IV, but have had patient at methadone clinic draw blood for the RPR for me from his member. We had tried fingerstick but no go so he offered, it worked.

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