Should ED put in lines before sending up arrest patients?

[Paris01]

We seem to be getting more arrests from ED that arrive with only a peripheral iv access. I am being told it's not their responsibility although it seemed to be for the previous 30 years. Is this the new norm?

[russianbear]

What sort of line are you referring to? Our protocol is two large bore IVs. Once ROSC has been achieved, if EKG reveals STEMI, we send them straight to cath lab, do not pass go, do not collect $200. If they are sticking around in the ED and are going to be put on pressors, yes, we get a central line in them.

[/username, BSN, RN]

What sort of line are you referring to? Our protocol is two large bore IVs. Once ROSC has been achieved, if EKG reveals STEMI, we send them straight to cath lab, do not pass go, do not collect $200. If they are sticking around in the ED and are going to be put on pressors, yes, we get a central line in them.

And in the cath lab, they'll get all of their lines.

[Nalon1 RN/EMT-P, BSN, RN]

If on pressors, then yes, otherwise 2 peripheral sites is the minimum, central line if time permits.

It also depends on facility. If you have an ICU intensivist or resident, then they should have no issue doing it themselves once upstairs.

But if you have residents upstairs, you probably have them downstairs as well...

[offlabel]

The more "lines" in the patient in the ER the less urgency the receiving service has getting the patient admitted. They want lines they can do them when they admit them to the unit of their choice.

[Lev, MSN, RN, NP]

The answer is yes. 2 peripheral lines (one large bore in the AC) is appropriate even if starting most pressors. Sure a central line is lovely but not always ED priority.The answer re: central line for pressors depends on institution specific policy.

[sjalv]

I'm an ICU nurse and am always enthralled when I get in report that the patient already has a PICC or central line, but I don't expect it. I do expect that the patient have two IV sites though. We have critical care nurse practitioners that work overnight who sometimes see the patients in the ER before they get a bed in the ICU, in which case they usually start the lines. The ER physicians rarely do unless multiple pressors are needed.

[jdub6]

2 IVs is the standard. Central lines placed in ED are supposedly more likely to be "dirty" (meaning both placed in groin and/or to develop line infections) because of the environment. Most pressors can run via PIV initially for a set time.

If the patient is really sick priority is getting to ICU (or cath lab or OR). ED job is to get them there alive with what they need to stay alive while ICU gets them "situated" with central/art lines and invasive monitoring etc. Staying in ED for procedures is not ideal-staff ratios generally are worse, rooms less well cleaned between patients, equipment may not be available and ICU is where the sickest SHOULD be. Again ED role is stabilize enough to get to next destination alive-nothing more.

[bclark297]

I've seen countless codes working in the ED. All managed through peripherals.

IV or IO will do the job. if you achieve ROSC and they're on gtts, then i would imagine a CVC being placed

[brap740, BSN, MSN]

Atleast 2 large bores. 3 preferably.

If they require pressor support then a line and central need to be placed as soon as possible.

ER might be slammed, how they gonna have time to put a central in if they're treating others that are sick?

I don't think there's a good answer for this. If they put a central in that's awesome. If not support the patient until one can be placed.

[canoehead, BSN, RN]

I suppose you want your lines untangled too? Darn ICU nurses.

[Kareegasee]

Fluids can run faster through a large-bore IV with no cap on it than any size lumen in a central line (other than an introducer). A central line isn't required right away, it's just a perk that makes things easier. ED nurses have actual stuff to worry about, and it's not making your job easier.

P.S. May I also mention that if you have time to worry about the central line not being there because you're not busy coding the patient, intubating, pressure packing fluids, etc., then you should thank the ED nurses for all the things they DID do?