IV's

[BabsD]

When a pt. complaints that an IV is hurting and even ask for lidocaine are we not suppose to D/C it? have the rules changed? I was told by Nightingale's DON (and I use the term with not much confidence that she knows what she is talking about) that she might be a hard stick. I learned that this is no excuse for leaving and IV in that is hurting a Pt. So what is up with this?

[SoldierNurse22, BSN, RN]

Are there actual clinical indicators that the IV is bad? Does the patient want the IV re-started regardless? What are the surrounding details to your scenario?

[akulahawkRN, ADN, RN, EMT-P]

I would have to echo the above... more details about the situation, please. I will say that as a general rule, if someone's complaining about a painful IV, I'm going to ask them if they want a new IV or if they're OK with the current one. I'm not likely to find a way to put lidocaine around an IV site because that can mask pain that's caused by an IV that's continuing to go bad. I'll offer to change the IV out, but as long as there's no other indicators of phlebitis and the patient is tolerating it... it's up to them.

I'll also start a 2nd IV before I d/c the first one for "hard stick" reasons...

[Been there,done that, ASN, RN]

Do not reveal the name of your employer/ facility.

That being said.. if your patient reports pain at the site.. it requires your immediate assessment. In 30 years of nursing.. if my patient reports pain at the site.. it's all I need to pull it.. and secure another site.

You must advocate.

[akulahawkRN, ADN, RN, EMT-P]

Do not reveal the name of your employer/ facility.

That being said.. if your patient reports pain at the site.. it requires your immediate assessment. In 30 years of nursing.. if my patient reports pain at the site.. it's all I need to pull it.. and secure another site.

You must advocate.

During my last semester, I had a patient that had a painful IV and he chose to keep it in much longer than he really should have. I suppose that for some reason he thought that IV's were supposed to be a bit painful, so he just tolerated it. There weren't any signs of phlebitis or infiltration that I found, but it was persistently painful. From the moment I noticed that it was painful to him, I offered to start a new line. Eventually he took me up on the offer (I guess being a student wasn't too inspiring?) and easily established a new, patent, and pain-free line.

The look on the patient's face was just, well, priceless! He learned something that day... IV lines aren't supposed to be painful!

While the old line was patent, clearly it just wasn't a good line. Once it becomes painful to flush or even touch, then it's time to start thinking about establishing a new line.

This is something I was taught many years ago. Back then, I worked in the prehospital and IFT settings. It was rare that I got a patient with line that was going bad...

[BabsD]

I was following another nurse, I have been a nurse 30 years and work in many different Hospitals I would have handled it much the same way. Pt. did not indicate one way or the other. Just stated it was hurting. Very nice lady I think she had some medical experience. The nurse I was following did none of this. Kinda just blew it off while her husband rolled his eyes. More details might turn into bashing other nurse. I'm sure if you have been a nurse any amount of time you have come in contact with personality conflicts between two nurses. Sorry for saying the name of agency and title of person.Thought She might know something I didn't.

I was taught if a pts is in pain you try to alleviate it. After assessing it to provide comfort and I have never heard of just leave it in because they could be a hard stick. Thank you so much for your great professional knowledge Soldiernurse, been there done that, and akulahawk. You have been a great help.

[Gabby-RN]

Patients in the ED often tell me their IV hurts...hurts when they bend their arm, hurts when they touch it, hurts when they look at it. Usually they just hate IV's. If I cant find an actual problem with the line to indicate a need to change out the line I still always offer to start an IV elsewhere to see if it's more comfortable and then discontinue the IV. I am usually told "No! I hate being stuck I will deal with it". I let them know I will be more than happy to do it if they change their mind. Sometimes the patients pain isn't even related to the catheter, when they turn their wrist a certain way the tegaderm pulls on their skin or arm hair or other minor things. Regardless what I have experienced is that 9 times out of 10 the patient just wants to vent about the IV but doesn't want anything done about it-well except for their problem to go away so they can get the IV out and go home.

If the patient is in the midst of a workup, and the IV flushes and aspirates well, is not inflamed nor indurated nor edematous, and not especially tender to palpation -- and not running something caustic -- I'd probably be inclined to leave it be unless the patient is insistent that it be relocated. If they're being admitted then I would certainly start a new line.

"It hurts" means a lot of different things and, by itself, is not necessarily reason enough to start another line. I would, however, take a look to see if I can find a more suitable location and watch it like a hawk (or an akulahawk?)

And I NEVER d/c a patent IV before securing secondary access... it sucks starting a code with no venous access.