Courtesy IVs

[Aprz]

Honestly, I don't get this. To me, it's not a courtesy for the hospital; I'm not doing it for the hospital. I am doing it for the patient.

What's the benefit of not utilizing time that the patient is with us, so that the patient can wait for the hospital to do it? While rare, what if the patient deteriorates, and now we or the hospital are stressing about doing it?

I can also see this making IVs like intubation*. Just another infrequent skill that we will become bad at, and then it'll be discussed whether we should keep IVs or not. It's a great step towards making us just ambulance drivers again. Maybe this is just a problem for systems like mine that are 100% ALS response, so I usually respond to a lot of "BLS plus" calls where I am going to start an IV and monitor them (eg chest pain, mild dypsnea, dizziness, nausea with normal vital signs that I could treat with Zofran ODT).

*To combat this problem in my county, my county has made it a requirement for us to do laryngoscopy on 100% of cardiac arrest or before using a King airway. Prior to this, out success rate was extremely low, and paramedics would rarely intubate. I know for myself, the amount of intubation I have done has gone up as well as my success rate.

I don't recommend doing IVs on calls that totally don't need it at all - like the hospital isn't even going to do one. I just don't see the point of waiting for the hospital to do it when you think the patient is eventually going to need one.

 

[hometownmedic5]

Honestly, I don't get this. To me, it's not a courtesy for the hospital; I'm not doing it for the hospital. I am doing it for the patient

The courtesy to the hospital is doing a job for them that saves them a few minutes they could better spend on one of their other patients (or gunning down their lunch or using the toilet).

Again, in some places this is a bs theory; but in some places(like my hospital), they really really appreciate the effort and reciprocate by helping me when I need it. Perhaps this doesn't apply for you, but in some places it's a thing.

 

[DesertMedic66]

Honestly, I don't get this. To me, it's not a courtesy for the hospital; I'm not doing it for the hospital. I am doing it for the patient.

What's the benefit of not utilizing time that the patient is with us, so that the patient can wait for the hospital to do it? While rare, what if the patient deteriorates, and now we or the hospital are stressing about doing it?

I can also see this making IVs like intubation*. Just another infrequent skill that we will become bad at, and then it'll be discussed whether we should keep IVs or not. It's a great step towards making us just ambulance drivers again. Maybe this is just a problem for systems like mine that are 100% ALS response, so I usually respond to a lot of "BLS plus" calls where I am going to start an IV and monitor them (eg chest pain, mild dypsnea, dizziness, nausea with normal vital signs that I could treat with Zofran ODT).

IVs are much more frequently used than intubation. I still start at a minimum 5 IVs per week on patients that need medications or fluids where as I honestly haven’t intubated anyone since my OR time in medic school. Some weeks I start much more and some weeks I start less. I do not feel that not doing courtesy has or will have had any chance in my IV skills.

In hospitals that make sure to replace EMS IVs within 24 hours are we actually doing the patient a disservice by starting a line on a patient that we are not going to give any meds of fluids to? Sure they have a line but the patient will get another line started.

Since we have stopped doing courtesy IVs our hospitals have been better able to triage patients into the lobby or other treatment areas. We have one hospital that would routinely tell us “he guys, pull your IV out and put the patient in the lobby”. So I just started an IV on a patient who did not get any medications or fluids and no bloods were drawn. I just waisted equipment, increased the cost of the transport to the patient (if you charge for IVs) and caused the patient unneeded pain and could have possibly increased the patients risk for an infection.

It’s hard for me to say “well, I did it for the patient” when I did a procedure that was not indicated for my patient and I am not going to do anything with it.

I’ll do my call in and inform them I am bringing in the patient BLS. If they would like an IV they can let me know.

 

[VentMonkey]

I’ll do my call in and inform them I am bringing in the patient BLS. If they would like an IV they can let me know.

This^^^. A lot of the "questionable" patients I get I may throw in a quick "this is a BLS patient/ transport unless you want an IV..." to the hospital when giving a radio report. 9 times out of 10 they don't, which is fine, but if they do then it's no big deal either.

I really don't think that this is a huge issue in our area, and we don't have a protocol or policy telling us when, or when not to start lines.

 

[Aprz]

The courtesy to the hospital is doing a job for them that saves them a few minutes they could better spend on one of their other patients (or gunning down their lunch or using the toilet).

Again, in some places this is a bs theory; but in some places(like my hospital), they really really appreciate the effort and reciprocate by helping me when I need it. Perhaps this doesn't apply for you, but in some places it's a thing.

I am not sure if you're on the same team as me? Lol. I am saying that I think we should we should be doing it if the patient is going to eventually need one, even if we ourselves don't plan to give medications or fluids.

I can see why this is an issue for people have their IV replaced within 24 hours and/or the line being yanked to put them in RME. The 24 hour thing I think is still not that big of a deal since mosg patient usually aren't staying at the hospital for 24 hours, but will still get blood draws, fluids, meds, or a scan in the emergency department. As far as I know, this isn't an issue where I work at. I guess it's area dependent. What's deal with hospitals doing this?

 

[johnrsemt]

I used to work IFT and did a lot of hospital to hospital (little hospital to large hospital for cardiac cath was always good) one hospital always transferred a patient out with a patent 24 g IV; I always had a 18 or 20 g by the time I got to the larger hospital: cardiac issues, if I need to push fluids or meds I needed larger IV, and Cath lab needs at least a 20 g.
Cath nurses would get the report from the small hospital and be ready to put a new line in when we showed up, and were always happy to see it was done. Got invited to stay and watch a lot of cath's done because of that. Got a few free meals too

 

[Akulahawk]

I used to work IFT and did a lot of hospital to hospital (little hospital to large hospital for cardiac cath was always good) one hospital always transferred a patient out with a patent 24 g IV; I always had a 18 or 20 g by the time I got to the larger hospital: cardiac issues, if I need to push fluids or meds I needed larger IV, and Cath lab needs at least a 20 g.
Cath nurses would get the report from the small hospital and be ready to put a new line in when we showed up, and were always happy to see it was done. Got invited to stay and watch a lot of cath's done because of that. Got a few free meals too

IFT is a different beast. In those instances, it is expected that patients will have IV access. If all the patient has is a 24g cath and you can place an 18 or 20g, then go ahead and do it. Sometimes the only access that the sending facility can place is a 24g but after some fluids, the veins open up a bit and you can place something larger. The sending facility in those cases likely isn't re-evaluating the ability to place a larger line so the patient gets sent with the 24g. I'm pretty good at getting lines and if I can only place a 24g, that's the best I can do. Last night I had a very dehydrated elderly gentleman who had ONE usable site (that I was allowed to access) and the best line I knew I could place in that site was a 22g. I would have liked to have had at least a 20g or even an 18, but... even after a liter, he was still pretty well clamped down, so the doc had to place an EJ. Only after about 2.5L in did I see some significant inflation of peripheral veins that were big enough to reliably place a 20g.