Butterfly or No?

mycrofft said:
Akula I was working Methodist ER (before the Grey Sisters took it over) and we had to bite our tongues sometimes when we saw the IV's coming in. House policy was to DC every field IV, but sometimes they left no unpunctured veins for the OR to use. (We could always weasel something).
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Given the mentality of the II's back then, I'm not surprised. You'd have had a really hard time distinguishing one of mine from one of "yours"... In any event, I always left a vein (or a bunch) for the ED to use. Policy is still to DC every field IV within 24 hours, as far as I know.
 
...and maybe infection control studies? Or just covering fanny despite (lack of?) any scientific proof of infection rates for field starts?
 
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Levine, R. et al Comparison of Clinically Significant Infection Rates Among Pre-hospital- Versus In-hospital-initiated IV Lines (1994) Annals of Emergency Medicine 25,4 p502-506

In 3185 IV starts, 4 significant infections found in the in-hospital cohort, versus 1 in the pre-hospital cohort. No significant difference.

IVs get changed out every 24-72 hours anyway, so all they are doing is making another port of entry by pulling one out straight away.
I have had some glorious facepalm moments when some clever person pulls my IV out before establishing another, and then spends half an hour trying to get another one before having to get someone in with an ultrasound to do a jugular.
 
mycrofft said:
...and maybe infection control studies? Or just covering fanny despite (lack of?) any scientific proof of infection rates for field starts?
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I've looked at a bunch of studies, and the vast majority show no difference in infection rates between EMS and hospital initiated IVs, and infact, the few that do show a difference tend to show more infections from hospital-initiated IVs, but they're all within the allowed margin of error.



Again, based PURELY on money. Nothing more.
 
Then they are just covering their butts and charging for another IV start.
 
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