I know several hospitals in the areas where I work, that unless they need it immediately, will pull field (Intermediate or Paramedic acquired) IVs for fear of infection. This brings up a few questions for me (I use "us" and "our" terms to specify EMS (ILS and ALS personnel), not necessarily myself):
1) What really is the rate of infections (phlebitis, etc) for field lines compared to hospital lines? Are there any studies that I have missed on my pubmed search?
2) What makes our aseptic technique so different from theirs?
3) Is an infection from one of our lines considered a "never" event for hospitals (CMS won’t pay...?) How is it determined that it was our fault? Is there a threat to our billing for an infection?
4) What effect do these standards have on the number of patients accessed in the field (the ILS service I worked with gave a lot of patients’ lives TKO "Just in case the hospital needs them")? What effect does these staff performing fewer procedures have on the times when a patient really needs a line?
5) What effect does this assumption of contamination have on pre-hospital blood draws, by said agencies, which, after they draw the blood, just leave the line in TKO?
Is this moving the way we see endotracheal intubations going-- services moving towards mandating Kings or LMAs for arrests because field tubes are pulled and replaced anyway? Services allowing for CPAP instead of intubations for CHF/COPDers?
Again, I really am not posing this as an ALS v BLS question. It also isn’t "Should these procedures still be performed in the field", but more of "is all of this in the BEST long-term interest of the patient"?
Thanks to all who reply constructively.
Dan
1) What really is the rate of infections (phlebitis, etc) for field lines compared to hospital lines? Are there any studies that I have missed on my pubmed search?
2) What makes our aseptic technique so different from theirs?
3) Is an infection from one of our lines considered a "never" event for hospitals (CMS won’t pay...?) How is it determined that it was our fault? Is there a threat to our billing for an infection?
4) What effect do these standards have on the number of patients accessed in the field (the ILS service I worked with gave a lot of patients’ lives TKO "Just in case the hospital needs them")? What effect does these staff performing fewer procedures have on the times when a patient really needs a line?
5) What effect does this assumption of contamination have on pre-hospital blood draws, by said agencies, which, after they draw the blood, just leave the line in TKO?
Is this moving the way we see endotracheal intubations going-- services moving towards mandating Kings or LMAs for arrests because field tubes are pulled and replaced anyway? Services allowing for CPAP instead of intubations for CHF/COPDers?
Again, I really am not posing this as an ALS v BLS question. It also isn’t "Should these procedures still be performed in the field", but more of "is all of this in the BEST long-term interest of the patient"?
Thanks to all who reply constructively.
Dan