Trouble with infusion and the AC stick.

Specialties Infusion

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I am a very seasoned RN who has been working on a solution for the many AC sticks we receive on the floor from the ER and OR. These units all have very good reason to use the AC and even though the problem has been brought up by management at my facility several times, no changes have taken place.

We as nurses are great innovators. We think in ways no one else would to problem solve and make our lives and patient's lives easier. Nothing is as disheartening as the patient who c/o the alarm going off so frequently they cannot sleep. All nurses experience alarm fatigue as well.

There is a solution. My first job as an RN was at Emory University Hospital in a brand new field-Rehab. I had the good fortune to work closely with PT and OT to splint patients for various problems. That is when I was introduced to the inner aspect of the arm for prevention of contractures.

My next logical step with the AC IV was to work in the same fashion. A cylindrical device in the inner AC works like a pipe bender and the IV cannot kink.

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Specializes in Trauma Surgical ICU.

I just avoid the AC if at all possible[emoji6] but I'm not ED. I will go there if they have to have a CTA or no other side found.

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So, you want to apply a splint to prevent the patient bending her or his arm? Why not restart the IV?

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Specializes in Pediatric Critical Care.
So, you want to apply a splint to prevent the patient bending her or his arm? Why not restart the IV?

Yes the splint sounds disheartening too.

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Ultrasound is vastly under utilized, imho. There are at least as many large, deep veins in the forearm as there are AC veins (cephalic, basilic). It requires a little instruction and skill as well as longer IV catheters, but ultrasound access to deep forearm veins avoids the problem cited all together.

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Sometimes time is short or the patient needs Vanco or some other abrasive antibiotic. An AC stick can work and the patient can bend their arm as usual. Vessels can follow the pathway of an outer object-spacer. It is an alternative fix.

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As a patient (frequent patient, have hx of SLE (for 12 years, so my veins are shot from the disease and prednisone), DVT, hyperemesis in all five pregnancies, and a failed spinal fusion L4-L5-S1, I know that I am a very tough stick. I had to have PICC lines inserted for fluids during all of my pregnancies, two of which got staph-infected and had to be removed and IV antibiotics administered inpatient for seven days or more. When I have to go to the hospital, I'm happy if they can get an IV, even if it means I have to wear a splint for the AC stick. They had a "vein finder" in the L&D unit that I was admitted to for a week this past time, and it lit up the deeper veins with infrared lights (I think...I am a student so forgive me) and so they only had to get one stick. I agree the u/s is vastly underused. When a patient is in pain or in desperate need, minimizing needle sticks is a merciful courtesy. I know that it is different in the ED...this past hospital stay I had a 24 inserted in the ED for fluid and medication administration, only to be admitted up to the high-risk antepartum unit and have them pull it and put in a 22 for antibiotics. I don't know how valuable any of this info is, just have been a patient a ton of times and gone through ten-plus needle sticks in one sitting before. No Thank You!

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