IV or no IV?

[HotelCo]

EMS IVs are generally saline locked once the patient is in the ER, and another line is started for bloodwork and as a route for medication. The EMS line is only a backup.

Some hospitals here just pull the EMS line all together once they establish access.

 

[Aidey]

Depends on your local system. If your hospitals are anything like the ones around here prehospital lines are considered "dirty" and pulled within 24 hours (often it's pulled if the pt is admitted). So if you start a line on a pt that you won't use, technically you have done your patient a disservice by making them get stuck twice. The flip side is that most patients getting admitted probably need access because they are sick.

My personal policy is: if there is a chance I need to use an IV, i'll get one. If Fred is going to the ER because he is having neck pain after a low speed MVA, he just gets a ride.

At our local hospitals both the pre-hospital and ED IVs are considered "dirty" and pulled within 24 hours if the patient gets admitted. As long as our line works the ED will use it.

 

[Shishkabob]

Honestly, I hate when they label them 'dirty'.


The studies on infection rates among pre-hospital and in-hospital rates are minimal and far in between, pretty much split even saying one is more infectious than the other. This is an outdated CDC 'guideline' that is not backed by evidence, but IS backed by the IV nurse group, and leads to the ability to bill more for the procedure being done.


It's money. That's all it is.

 

[Aidey]

Of course it is. When I was admitted to the hospital the only reason I let them restart my IV is because it was in my AC. I was going to be there for a few days and it was already annoying the hell out of me. If my IV had been in a less annoying spot I would have refused to let them touch it. Especially since it took them 3 bloody tries to restart it. For the record, I'm a fairly small female with great veins. I was ready to tell them to fark off and I would start it myself.

 

[jjesusfreak01]

Anecdote from my first ALS field clinical (IE, me and two medics on a truck) this past week. Had a possible TIA patient, partially resolved and perfectly stable from the minute we saw her to drop off in the ER. Wanted to start an IV, looked for sites, nothing appeared with the tourniquet applied. She had one vein on the side of her wrist, and mentioned she often passed out when people started IVs on her. Figured if she seizes the medic is going to push Versed IM, so an IV wasn't really that big of a deal. Medic agreed. Thoughts?

 

[the_negro_puppy]

Anecdote from my first ALS field clinical (IE, me and two medics on a truck) this past week. Had a possible TIA patient, partially resolved and perfectly stable from the minute we saw her to drop off in the ER. Wanted to start an IV, looked for sites, nothing appeared with the tourniquet applied. She had one vein on the side of her wrist, and mentioned she often passed out when people started IVs on her. Figured if she seizes the medic is going to push Versed IM, so an IV wasn't really that big of a deal. Medic agreed. Thoughts?

Would have done exactly the same.

 

[Melclin]

If my assessment shows the pt might need one eventually I'll go ahead and start it. That's kinda what's needed. However if my assessment shows they wont eventually need one I won't.

This.


I'm super careful (more than I need to be really) about infection control. So I see no issue with hospital vs prehospital. Some of our hospitals will pull prehospital IVs in certain pts later down the track. They probably should. In certain circumstances, our IVs are not started in optimal conditions.

We can use saline locks, amongst other things, and I see no reason why a pt cant sit in the waiting room with one. I've put a few in the waiting room with them in.

I've heard alot of things about which veins hurt more but I've never noticed any particular pattern personally. The biggest determining factors seem to be distraction and the speed at which you get the line.

 

[Chief Complaint]

I have no general rule when it comes to starting IVs. Its very situational.

Some people need one, others dont.

/thread.