dmurph615

Here's an interesting article: The American Journal of Emergency Medicine "A new site for venous access: superficial veins of portal collateral circulation" And another: Thoracic or Abdominal Wall Veins Are Acceptable Sites for Intravenous Access -- This was actually a study performed by two doctors at St. Louis University in St. Louis, MO. And to add to the story. The line was dc'd once he received some fluids (approx 2 hours), after he got some hydration his veins easier to access. Also, just keep in mind that this facility is behind the times, no IOs, no vein vinders, no ultra sound, no anesthesiologist or PICC Line nurse (not at night anyways), and the EJ had been ruled out due to the patient shaking his head back and forth too much. And there is no policy prohibiting this. No one ever said this was "ideal," however, under the circumstance, it worked! And the patient's condition improved in part bc of this IV. And in the end, isn't the patient outcome what's most important? Thanks for all the input and suggestions, I do think this is something that needs to be studied more, because apparently in the cases it has been looked at there has been some success. My goal is to push for IOs and EJs for my department, since we are in the 21st Century...

Rationale? You really want a rationale for why a peripheral line is safer than a central line? It's a more invasive procedure, higher risk of infection, etc.. And obviously the doctor saying it's okay isn't what I needed to start the line, but research articles and word of mouth from experienced clinicians is enough. The patient didn't receive phenergan or any other dangerous medication. He needed FLUIDS! And he got them in a safe and effective manner.

There is no rationale other than they've carried clip boards too long, they are behind the times and choose to stay behind the times...

Keep in mind I work at a government facility where things aren't exactly the same as private practice, EJ access was sketchy, the doctor and I looked, but the doctor decided against it due to the patient swaying his head back and forth constantly (tweaking), so once we noticed the vein, and the MD didn't oppose, we decided to use it. Obviously this wasn't our first choice, but in the ER, sometimes you have to do what you have to do to help improve the status of the patient. And as far as an anesthesiologist, haha, no way you could have gotten one of those in this facility.

Correct, except IOs are not permitted, and I can't start a central line, so I did what needed to be done to get fluids and meds in, then let the ICU figure it out from there.

I agree, our facility does not permit IOs (ridiculous I know) and EJs can only be placed by a Physician. This Physician looked at the EJs but the patient was moving his neck back and forth so much it wouldn't have lasted a minute. The abdominal IV worked great...

Keep in mind, at my facility IOs are not permitted (I know, ridiculous), and EJs can only be performed by Physicians (which this patient didn't have very good EJs), so the Physician was okay with this location. But the Nursing Supervisor decided to take matters into her own hands. There is no policy against it in my facility, and the entire team of ER Physicians feel as though it was appropriate. I've always been taught a peripheral IV is much more desirable than a central line...

Recently in our Emergency Department we had a patient going to the ICU who is a frequent flyer, substance abuser, with very difficult veins. Multiple attempts at a peripheral IV were attempted in the hands, forearms, antecubitals, feet, and legs, until we came across a very straight, juicy, superficial vein in the abdomen. The catheter was placed just like in any other site, blood return, easy flush, etc. A supervisor walked by and saw this and now I am getting detailed from my department because she says this is an "inappropriate site" for an IV. When I asked "Why?" She stated because she's never seen one there before. Now my colleagues say they have seen this before, and the ED Physician backed me as well, but I was wondering if anybody else has done this or seen it done? And if there is any literature supporting or opposing this as an appropriate IV site. Any information would be greatly appreciated. And FYI, the site held up through 2L of Normal Saline and some much needed meds until the patient pulled it out.