What do you start IVs with in your OB unit?

[LNDRN2]

I work L&D on the Jersey shore & we get a lot of grand multips... we use either 18G or 20G angios for our IVs... it's like practically sticking fork prongs in people, but it's our policy! Just out of curiosity, what do you guys use?

[NurseNora, BSN, RN]

If you ever need to push blood products in under pressure, you'll be very glad for that 18ga. I believe that is standard for OB. We only put in a 20 ga if it's impossible to put in a larger one.

When I worked at the big city medical center where we did VBACs all the time, we were OK using an 18. I've only put in 16 ga when someone came in bleeding really badly with a previa or something like that.

[ragingmomster, BSN, MSN, RN]

Our policy says all laboring pts require 18g IV's. That is unless you are a VBAC. Then you are required to have a 16g IV. :dzed:

Is this in order to discourage VBAC'ers? What is the possible evidence that states a woman who wants to VBAC needs a bigger IV than a woman who arrives for a scheduled c/s?

[LDRNMOMMY, BSN, RN]

18 ga unless we just cannot get an 18 ga we will put a 20 ga in. I will sometimes start with a 20 on a triage patient who comes in for IV hydration with n/v.

[massbaby]

When you say forearm where middle high low what about securing it and why the forearm not hand?? Just curious

[wtbcrna, MSN, DNP, CRNA]

When you say forearm where middle high low what about securing it and why the forearm not hand?? Just curious

The outside middle to upper forearm is a lot less sensitive than the hand or wrist. The OB department where I trained preferred to have their IVs in the forearm because they felt when the women were in the pushing position the IV tended to kink or get accidently pulled out more often if it was in the hand.

[RNBelle]

We give everyone a 18g, unless they have tiny crappy veins then I will put in a 20g. We just switched over to nexiva IV catheters.....talk about a learning curve. The only ones who are doing good with those are the new grads because they don't know anything different.

[newrn2010]

We use 18g but we also use lidocaine before start.

[NurseInTexas12]

We use an 18g on everybody, and we don't have any smaller caths stocked on the unit. Anesthesia has smaller IVs in their cart for absolute emergencies if they aren't able to place an 18g either. We're not allowed to start IVs in the AC because we don't want them to kink off when the patient has her arm bent and is holding her baby. (We bolus LR with Pitocin on everybody after delivery of placenta by protocol, and the docs want it going in as quickly as possible.)

How do y'all feel about administering lidocaine before IVs? We don't do it at my hospital, but I disagree with the practice because it seems like it just subjects the patients to an unnecessary extra stick and a burn.

[klone, MSN, RN]

18g is preferable, in case she needs a C/S. We'll do 20g if she's a hard stick. If she's antepartum with little/no chance of needing surgery (such as for rehydration), I'll just automatically start with a 20g. I usually use the hand as first choice, because those are the veins I'm best at.

[wtbcrna, MSN, DNP, CRNA]

We use an 18g on everybody, and we don't have any smaller caths stocked on the unit. Anesthesia has smaller IVs in their cart for absolute emergencies if they aren't able to place an 18g either. We're not allowed to start IVs in the AC because we don't want them to kink off when the patient has her arm bent and is holding her baby. (We bolus LR with Pitocin on everybody after delivery of placenta by protocol, and the docs want it going in as quickly as possible.)

How do y'all feel about administering lidocaine before IVs? We don't do it at my hospital, but I disagree with the practice because it seems like it just subjects the patients to an unnecessary extra stick and a burn.

I usually don't use lidocaine unless I expect it to be a difficult stick or I have already stuck them once before w/o any luck. You can also use saline instead of lidocaine. Saline will decrease or eliminate most of the feeling right at the insertion point if correctly placed. The best thing to do to decrease the pain with IV starts is to use 9/10 lidocaine to 1/10 Na Bicarb it takes the sting out of the lidocaine and causes the lidocaine to act much quicker.

[rdnkmommy]

18 ga for every IV.