Placing IVs in shoulder, breast, upper chest

[paphgrl]

When I have encontered patients with difficult IV access I have placed IVs in shoulders and sometimes in veins of the breast. I have had good success with these sites. I have not seen other nurses do this. Has anyone ever utilized there peripheral veins? Are there any contraindications that prevent RNs from utilizing these sites?

Your input is valued,

PG

[Okami_CCRN, BSN, RN]

I have seen 24g IV's placed in the upper arms of patients with difficult IV access, I have yet to see IV's placed in the shoulder/chest/breast. I would strongly advise against as infiltration in the chest and breast tissue could cause severe tissue damage to the point where surgical intervention may seem necessary. If patient's access is so poor that you feel compelled to start an IV in a place that is "unique" I would speak with the attending in regards to a PICC line, or Triple Lumen Cath if necessary.

Just my two cents.

[caroRN]

I have occasionally seen PIV's in the shoulder/chest/breast in hard to stick patients but recently my hospital (or at least my floor) has stopped this practice because of the increased risk of infiltration and complications from infiltration. These patients are better served by a PICC or central line anyway. Maybe time to call the doc for an EJ if you need immediate access and PICC or central line cannot be completed for some reason?

[SonorityGenius]

No, and I will never even attempt there either.

[MomRN0913]

I've seen a hard stick close to the axillae. I was very impressed.

[RockingItInTheER]

Recently had pt transferred from another ED with a line in her breast that infiltrated in route and caused a horrible infiltrateI have stuck the upper arm but that's my limit

[CoolhandHutch, MSN, RN]

What's the hurry? Is your patient crumping? Then IO or EJ. For routine stuff, I've done upper arms up to the shoulder. Seen a boob done once, didn't really see the point. Occasionally would do feet in non-diabetics but that's getting phased out in most hospitals. I haven't seen any literature that finds a greater incidence infiltration from "non-traditional" sites but that's mostly because I haven't looked. Most hospitals would/should have a policy about PIV sites. Don't bother asking the doc if you can do it somewhere unless you know what your policy says.

[That Guy, BSN, RN, EMT-B]

No, and I will never even attempt there either.

Why?

I started one in the chest the other night in a pt that needed one stat and had no other viable access. We did it while waiting for an IO gun. They are by no means meant for long term but in a pinch, they work well.

[psu_213, BSN, RN]

I have seen and attempted in the shoulder area and the chest--they would have to have very poor access otherwise. If/once they are admitted--then IR can put in a PICC. I have heard about the breast, but never seen and I would not go for it except in emergent situations.

[noyesno, MSN, APRN, NP]

Seen two in the boob.

Both were waiting for a PICC line to be placed.

[Spidey's mom, ADN, BSN, RN]

Upper arm or foot but not breast/chest.

I'm a huge fan of PICC Lines but we are a small rural hospital and the only CRNA who did them is gone now.

[Esme12, ASN, BSN, RN]

Yes I have, but they are for a SHORT, EMERGENT access. These have gotten less common with PICCS as the new alternative. They are fine but need a doctors order at some facilities and I would watch them like crazy as an infiltrate can be a big deal and God forbid a cellulitis. These patients need an alternative access.