Courtesy IVs

RocketMedic

RocketMedic

Californian, Lost in Texas
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So lately, I've been trying out this new "having a basic partner who wants to take calls", and I've found myself debating- on patients who are stable, BLS and non-interventional from my perspective, should we be routinely sticking them? For example, the elevated-but-expected "I kinda have diabetes" sugars of 200+, or the like. What are y'alls opinions on the matter?
 
While in your care, do they need fluids or Meds? Do you routinely draw bloods? Is it a protocol violation NOT to start a line?

If no, then it's BLS, and the ED can stick them.
 
I'm happy to BLS a patient that meets BLS criteria, if the medic likes driving, and doesn't mind me doing my BLS stuff, more power to them.

Sticking everybody, much like putting everybody on an NRB, shouldn't really be standard practice. Why gain venous access on somebody who doesn't need fluids or meds?
 
Our county placed a new policy stating we are to never do courtesy IVs. If we are not going to give the patient fluids or medication and the patient is stable then we are not to start a line. Even if we know the patient will be getting meds at the hospital or will get an IV at the hospital we still do not start them.

We still have medics who draw bloods and are still required to carry blood tubes. I haven’t drawn blood in well over 2 years. I got tired of handing the bloods over to the RNs and having them toss it in the trash.
 
My courtesty IV's are getting two on the really bad off people. If it's a stroke, heart problem, septic, etc then I will start one. Otherwise, they can do it if they want it.
 
If they don't need meds or fluids, and I dont feel the need for a just in case IV, they dont't get one.

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Any phrase with the term "courtesy" = trouble...nice guys finish last...or to put in another way, the enemy of good is better.
 
My understanding is if you're going to give meds soon, OR anticipating giving meds in the near future, then IV is required.
What about in the situation that you wont be giving anything, but you're almost certain that the hospital will use that line. Do you start one then?

For example. Weakness call. Stroke scale negative, BG wnl, 12-lead negative. You won't be giving anything, but the hospital will be using that line.
For me personally 9/10 in these situations I would, but just seeing what everyone else's perspective on it is.
 
ParamedicStudent said:
What about in the situation that you wont be giving anything, but you're almost certain that the hospital will use that line.
Click to expand...
This was addressed above. If you are anticipating that you are not going to be giving any fluids or medication, that's a "courtesy" start and if your protocols or service doesn't permit "courtesy" IV lines, you do not do it. As a paramedic, there are certain calls that I'll start a line because I anticipate that I'll be giving meds or fluids before handing the patient off to the ED. This is not a "courtesy" IV line because I expect to actually use the line. If I end up NOT using the line, that's OK but that would be in the instance where I was actually expecting to use the line but didn't get far enough down a protocol before arrival at a hospital to actually do it. This should be a very rare instance. In my county, we call don't call these lines "courtesy" lines. We're told by County policy that we may not obtain vascular access under the term "precautionary." This is squarely in the instance where you think the patient might need that vascular access but you cannot articulate a reason why you would be obtaining such access. In my ED/hospital, most of our patients that are placed in a room will have an order for a saline lock to be placed but we do NOT do these by protocol. A provider (MD/DO/PA/NP) will be ordering the placement. There will be times where I'll get aggressive and place a line but those situations are generally going to be time-critical and I know there'll be an order placed very shortly. At times the ED just is a different beast than anywhere else.
 
Courtesy lines are definitely a thing here. It's not that you would be formally disciplined for not doing it, but my primary receiving hospitals ER is half the size it needs to be for the population it serves, and understaffed to boot. They appreciate the help and in turn are there to help you when you need them. Also on the plus side, its a mechanical skill. Frequent use of that skill keeps competency high.
 
My criteria for gaining IV access:

Requires IV fluid for hypovolaemia, OR

Requires IV access for parenteral medicines, OR

The pt requires both referral to a medical facility, AND
The only suitable method of transport there is by ambulance, AND
They are likely to so significantly clinically deteriorate during transport to need IV fluid or medicine, OR
Gaining IV access changes what immediately happens to them (e.g. straight to theatre or CT)

If you don't meet one of those three, you don't need an IV.
 
Aside from the obvious calls where IV access is clearly stated in a protocol, I generally don't start a line unless I think I may put something in it.




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As a note, some hospitals (mine, for one) requires IVs that are started outside the hospital to be changed with 24 hours after arrival.
 
MackTheKnife said:
As a note, some hospitals (mine, for one) requires IVs that are started outside the hospital to be changed with 24 hours after arrival.
Click to expand...

Agreed. Most EMS IVs will be changed out quickly anyway so I do not think courtesy IVs are necessary. Having said that, those people who state that the culture of the ERs they go to expect IVs then they probably do not abide by that policy.
 
They very well might change them within 24 hours. For all I know they change them as soon as an admission order is written, or as soon as the patient gets to the floor. What I do know for certain is that the ED will gladly use my line and they dont typically board patients for days on end; so if my stated goal is to ease the workload for the ED and make them happy, then I have accomplished it. What happens next is somebody else's issue.

Different systems, different mentalities....
 
I hate starting an IV on a particularly hard stick only to walk into their room to say goodbye/grab the signature and seeing the RN/tech starting another line or drawing blood from a butterfly needle. So I have reached the point of unless I really need one, leave it to the ER because they are going to get stuck anyways. Don't know if this is actually relevant to the topic but it has been pissing me off lately.
 
All of our hospitals use our IVs for at least 24 hours and all will draw labs off them if we didn't already. Outside of complete BS patients, I can't really remember the last time I dropped of a patient with no IV, but it's been a bit of a run with the sickys lately.
 
We wouldn´t start IV´s for blood drawing, but we won´t wasit either untill we actually need one. If there is a reasonable chance that the stable patient, who does not need anything now, may require IV drug treatment or symptom relief enroute like antiemetics or analgesia or fluids, we´ll start the IV as a precaution.
 
The county I'm in is finicky at best. We actually have our IV kit set up with sets from each of the hospital and try our best to use their stuff if we are going to their facility. If the patient is bad they get what they get. More than once I've had nurses ***** that we didn't use the extension set they use, so if possible to keep the peace I start a line with their stuff whether I'm going to use it or not. All my local hospitals are affiliates of big medical schools and I feel the residents order 1 of everything on everyone so 90% of patients that come thru the ER get a saline lock.
 
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