|
I feel your pain.
We do, on rare occasions, leave an IV longer than our policy of 96 hours, but it does require the frequent assessment and documentation, plus immediate removal if there are any indications of problems. The MD order thing is another story. This is a nursing policy, and this is a nursing judgment issue. The MD order will not protect you in court if there was a problem. I would never bother with this, as it doesn't mean a thing to me, and I am not going to ask a doc to give me permission to use my own judgment on an issue that does not require an order. Normally, the MD is not even there to assess the patient.
Leigh Ann
Leigh Ann Bowe-Geddes, RN, CRNI
IV Therapy Specialist Infusion Services Department University of Louisville Hospital Louisville, KY 502-562-3530 >>> "Marianne Valentine" <[EMAIL PROTECTED]> 1/18/2006 3:31 PM >>> Hello,
I need some input from all of you. I know what Standard #55 states about short peripherals and site rotation. In an ideal world where everyone has great veins site rotation every 48 hour (or 72 hours if phlebitis rate of 5% or less) would be fine. However, we all know great veins are a rarity especially in the long-term care facilities. Routine site rotations can be extremely difficult. All situations are not black and white. Just this week I have had 2 difficult sticks. We service a few nursing homes managed by a large company who follows INS Standard #55 very strictly. I was called to place a midline into a resident who weighed over 600 pounds and needed 3 days of IV Unasyn. Needless to say I was thankful I got a regular short peripheral line in and he only was for 3 days. I could not find an appropriate vein at all. The next day I got called back to the same facility for a resident who needed 7 more days of IV Cefazolin (already had 3 days) and needed a site rotation. I suggested a midline and they got the order. By the time I got down there, the nurse had already pulled the IV out. Once again, this resident had NOTHING! No veins for a midline and I had a very difficult time getting a short peripheral in. The IV that was pulled out was without any complications and patent according to the nurse who pulled it and the resident's husband. The resident was a very anxious person who was! very upset about all the sticks. I have told the nurses not to take out a good IV until the new one is placed...common sense would tell you this. Some of the nurses are very frustrated. If the IV is without any signs or symptoms of complications, the physician is aware of poor venous access and gives an order to maintain the current site, and the site is cleaned and redressed and assessed every 2 hrs (facility policy) why not leave it in? I know the new standards are coming out...has this standard been addressed? What do all of you do in this situation? I know for a fact that peds pts keep their IV sites in longer than 72 hours. Any input would be helpful. There has got to be extenuating circumstances.... Regards, Marianne Valentine, RN, BSN, CRNI Director of Nursing Option Care of Cumberland 1-800-924-6497 [EMAIL PROTECTED]
This
message, including any attachments, is confidential, intended only for the named
recipient(s) and may contain information that is privileged or exempt from
disclosure under applicable law, including PHI (Protected Health Information)
covered under the Health Insurance Portability and Accountability Act (HIPAA) of
1996. If you are not the intended
recipient(s), you are notified that the dissemination, distribution, or copying
of this message is strictly prohibited. If
you receive this message in error, or are not the named recipient(s), please
notify the sender or contact the University of Louisville Health Care I.S.
helpdesk at 502.562.3637 to report an inadvertently received message.
----------------------------------------------------- |
