IV or no IV?

[ksmith3604]

Here's an argument that has come up in my system lately.....you are transporting a patient who is stable and "may" need an IV later, however they don't necessarily need one right now....do you start the IV during transport, or do you save it for the hospital. Is there anything wrong with starting on IV on all of your transports if there is any indication that they may need an IV later? Or should we be thinking that if we don't need the IV right now don't start it?

We all know that there are those patients that OBVIOUSLY need the IV, this is more geared towards that boarder line of needing an IV or not.

 

[fast65]

Eh, in that scenario I'll start an IV if I have time, why not make things a little easier on the ER staff?

 

[MSDeltaFlt]

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.

 

[ksmith3604]

Im still trying to figure out exactly how I would go about this. I totally agree with both sides. Start the line, do the ER a favor, save the pt a stick later....but then again, I can see not starting the line because i don't need IV access for a treatment right this second.

 

[CheifBud]

It's always that case by case basis just like many things in EMS. Try making this into a poll and we can see what we all think?

It depends on who is doing the IV mostly

If the person can hit it in one shot and do it well.... Knock yourself out otherwise let someone who isn't rocking around in the back of a van on double shifts do the IV.

I guess if you think it NEEDS to be done might as well get a jump on it. Save ER staff time to do other things.

 

[sir.shocksalot]

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.

 

[CAOX3]

Considering the difference in cost from a BLS ride to ALS. Why would we not attempt to keep the cost down?

If they dont need the line immediately they shouldnt get one especially since the ER is most likely going to pull it and put their own in and then charge the patient again.

As far as making it easier on the ER staff? Maybe but the benefit isnt worth the icreased cost your piling on the patient.

 

[medicsb]

Having worked at place where medics would place an IV close to 90% of the time especially when most didn't even need it. (at least in the prehospital phase). I always wondered if Medicare would eventually deem this practice unacceptable and maybe as far as considering it to be a form of up-coding, thus fraud.

 

[Handsome Robb]

Depends. Does the patient meet triage criteria ie waiting room? I work in a busy urban system and if the patient's condition isn't emergent and they can tolerate waiting in the waiting room I wont start one. They can't sit in triage with a saline lock, so if I do start one I just poked the patient for no reason and now I have to disco it, not a big deal but not very fair to the patient.

If I know they are going to an ER room I'll start a saline lock. I'm pretty confident in my abilities. I don't shoot for ACs. I like forearms

Do a lot of servies charge per treatment? We are flat rate + mileage here. Referencing medicsb's post about fraud.

Also, your guys' roads must really suck if you don't get a 10 second gap in the bumps to stick the line.

 

[ksmith3604]

Good call on the pricing. Not 100% sure about pricing in our system, however I think its more expensive to get a line in the bus rather than a line in the ER. Thanks for the posts....keep em coming!

 

[usalsfyre]

Good call on the pricing. Not 100% sure about pricing in our system, however I think its more expensive to get a line in the bus rather than a line in the ER. Thanks for the posts....keep em coming!

Just a note, I'm not sure a saline lock bumps the ride to ALS1 anymore by itself.

 

[WickedGood]

This is a good discussion. We have been having the same one at my station. We are mostly transport but we back up the 9-11 county system when we are needed. The general consensus is to stick an IV in (almost) everyone on an EMS call. I was a phlebotomist for four years before starting with EMS so I am very confident in my skills so it won't really cost time or pain to my pts so if there is any question I will go ahead and pop one in. The RNs are usually happy for us to do so.


I think really what it comes down to is what do your protocols say? A lot of our algorithms call for IV protocol even when no fluids are being administered. That way it is there if your pt starts to go downhill and needs meds or fluids pushed quickly.

Oh, and FWIW we are an Intermediate level station.

 

[traumamama]

If they are sick enough to ride in the ambulance then they are sick enough to have an IV. If they have a bad case of habius fakeritus then use a 14 guage.

 

[tssemt2010]

if im in a good mood, sure start one for the sake of the ER staff, or if i feel the patient will need medication or fluids during the transport yes, if none of the above, then no

 

[fast65]

If they are sick enough to ride in the ambulance then they are sick enough to have an IV. If they have a bad case of habius fakeritus then use a 14 guage.

No and no.


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[DV_EMT]

Well.... not that I start IV's or anthing but wouldn't it be a judgement call as far as what you anticipate happening (long transport time, posibility of deterioration, meds, history)? If everything is negative, forget about it?

 

[tssemt2010]

Well.... not that I start IV's or anthing but wouldn't it be a judgement call as far as what you anticipate happening (long transport time, posibility of deterioration, meds, history)? If everything is negative, forget about it?

pretty much what i was getting at, if they will need meds or fluid or think they will need meds or fluid, cover your *** and start the IV, you will be glad you did, if they are just being transported to the ER because they are a frequent 911 abuser that really has nothing wrong with them, im not starting a line on them

 

[the_negro_puppy]

If they are sick enough to ride in the ambulance then they are sick enough to have an IV. If they have a bad case of habius fakeritus then use a 14 guage.

Absolute crap. How do you judge if one is 'sick enough' to require an ambulance? I'm sick of people using the line "if they are sick enough to ride in the ambulance then xxxxxxx'. Bullocks. Use your clinical judgement instead of spouting crap like that. Many people who are taken to hospital in Ambulances probably don't need one. Doesn't mean thats justification for you to do anything you want to them.

IVs like many other procedures comes with a whole bunch of risks. IVs should be started on patient's who need intravenous intervention or who are likely to need IV intervention while in pre-hospital care. Punishing 'fakers' other people by inflicting pain on them is sadistic and poor patient care.

If you have trouble determining when a person requires IV drugs or may need IV drugs due to their injury or condition, further your education.

 

[lawndartcatcher]

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).

Wow. Does the CDC know about this? I know they published a study and a set of recommendations (I believe it was 2005?) showing that there was actually an increased incidence of infection when a prehospital IV is pulled and replaced in the ER because you're creating two holes in the patient instead of one.

 

[mycrofft]

Our local EMSA says "no IV-JIC*)

(*Just In Case). Decide if an IV is needed, and if so, start it and use it. No dropping in a line in case it is needed later and then dribbling in SNS.