IVs and catheters

Peripheral IV's are difficult to main in the home setting, therefore we do not maintain them at home - we do have many pt's who have central lines and we do maintain those. If a pt has no central line and we need to start a pca pump we will administer it SQ. If a pt is needing a greater volume than can be administered via a sq site then we will send them over to our inpatient facility to have a PICC line placed. Some of our pt's have foleys that were left in at the hospital. We place foleys in a lot of our pt's that are nearing end of life. It makes it easier to care for the patients and the patients are not needing to be moved as much - making it more comfortable for them.

Just wondering how many times Hospice nurses end up putting in catheters and IVs or do your patients usually already have caths in and if IVs are usually removed prior to being admitted to hospice. I'm referring to home hospice as opposed to a facility. Seems to me caths would already be in place and IVs removed, but wanting some expert advice. Thank you much

Thank you. When you refer to central line, is that a subclavian? (Can you tell I'm not a student yet??):selfbonk: Thanks again!

There are several types of central lines:

1. Portocath

2. Hickman or Broviac catheter

3. Groshong

4. PICC line

I'm sure you can find plenty of info on them by googling.

Hospitals are often in the habit of removing catheters before discharge. I often have to remember to specifically ask to have it left in if I feel it is appropriate. As far as lines, well, I've learned you can't predict what they will do! They usually leave PICC lines in unless you tell them to take them out, they usually take out heplocks, they usually take out central lines, and they usually remove the huber needles from ports. And even if you ask, it doesn't always happen.

It is rare that we need IV access. 99% of our patients can be kept comfortable using the oral, sl, transdermal or rectal route.

Hospitals are often in the habit of removing catheters before discharge. I often have to remember to specifically ask to have it left in if I feel it is appropriate. As far as lines, well, I've learned you can't predict what they will do! They usually leave PICC lines in unless you tell them to take them out, they usually take out heplocks, they usually take out central lines, and they usually remove the huber needles from ports. And even if you ask, it doesn't always happen.

It is rare that we need IV access. 99% of our patients can be kept comfortable using the oral, sl, transdermal or rectal route.

The hospitals here don't remove central lines and if the patient is going to the ICF then we'll ask them to leave the heplock in - they usually do because we are the ones that are in the hospital writing the orders. When I worked in the hospital pt's had to undergo a surgical procedure to have a Hickman or Groshong placed. It is my understanding that these would have to be surgically removed, so it would surprise me if this would be considered before discharge.

We don't use IV access very often either - but our ICF likes to have the access for more acute needs.

Thanks so much for all of the info!!

Our Hospice nurses do put in catheters quite a bit in the home. They have to be changed because they quit working (d/t sediment), or the dementia patient pulls it out, or they just need to be changed, or the elderly caregiver can't manage changing the spouse every time they urinate...so catheters are done. IV's are not done as often but sometimes IV antibiotics are given in the home so they are started. I work on an inpatient unit and I start more IV's then in the home d/t patient's coming in to get blood, rocephin or some other drug. I've probably placed 8 catheters in the last 8 months.