IV's in Stroke patients

kmoonshine, RN · Feb 3, 2009

I have put IV's in the affected side of a stroke pt. It's not my first choice, but sometimes you have to go where you can (especially in an emergency).

Gosh, I remember having a septic pt with left-sided paralysis; she was so dehydrated and had terrible veins; all the frequent lab draws on her unaffected side left me with little to work with. I ended up putting a 24g in her thumb on her affected side (left) and gave IV fluids until her veins "plumped" up a bit. However, I wouldn't give vesciant meds through an IV that was placed into a stroke pt's affected side (unless the pt was coding).

I think the thought is the stroke patient may have decreased sensation (which is bad should an IV blow) and decreased blood flow on their affected side (esp. if they no longer use that side; muscle will atrophy and the vasculature won't be as good compared to the unaffected side).

Sorry, don't know any credible sources online...

Scorpio, MSN, RN · Feb 3, 2009

Hi,

What I learned in nursing school is to always attempt to insert an IV in the UNaffected side of a stroke patient. Rationale behind this is that if the IV infiltrates or the vein gets phlebitis, the patient will not be able to feel the pain or coolness of those problems if the IV is in the affected side. Of course you always do your own IV assessments per protocol, however an IV could look great when you assess at the beginning of the shift and within an hour or two become infiltrated! If there is a vesicant solution running i.e. potassium, and the patient could not feel the IV infiltrate or report any pain to you, then a lot could happen in that time frame!

You could always look at your hospital policy regarding IV therapy or ask your nurse educator as they are GREAT resources. Hope this helps!

-CubbyRN

truern · Feb 3, 2009

http://tinyurl.com/dzrqrl

"Avoid IV lines on the affected limb"

http://www.scrmc.com/PDF/ICU%20Acute%20Ischemic%20Stroke.pdf

"Maintain three venous access sites."

I found these online. The first is a textbook for NPs. Seems to me "avoid" means if you have good access elsewhere go there....but if you don't you could use the limb. Per the second source you're to maintain three IV sites. If you don't use the affected limbs I'm at a loss as to *where* to maintain them.

DebanamRN, MSN, RN · Feb 3, 2009

It the pt is aggitated, I will use the affected side for access. This way the line is maintained. Later, when the pt is calmed down and if they are admitted, it can be changed. Frequent assessment of the site helps prevent any IV site problems. Some folks with long-term strokes veins are used up on the unaffected side.

VAJenny · Feb 3, 2009

Thanks for all the replies--this really helps!

Steve RN BSN · Feb 3, 2009

In an emergency situation you want at least 2 large bore IVs. I personally dont descriminate between affected and non-affected sides.....If they have a vein I go for it. Chances are they are going to get an 8-12fr central line by a resident in the ICU. When the pt is stable enough to tranfer to med/surg I would assume a prudent nurse would have an IV in the non-affected side due to rehab/sensation of the affected side.