I can appreciate the need for a large vein to inject contrast
agents rapidly to obtain the best pictures. I can understand why they
want to use the large veins of the AC. I also believe that the flow
rate capabilities of a 20 g are not significantly different from an 18
g and that a 20 g would be sufficient to achieve the flow rate needed,
usually around 5 mL per second, but I would want to confirm this with
the catheter manufacturers information.
But there will be additional risks for the patient and the staff
to use veins in this area of joint flexion. Almost all legal cases I
have reviewed involved IV sites in areas of joint flexion that were
not properly stabilized and supported to prevent catheter movement and
joint motion, both critical elements. I do have a case now that
involves an infiltration of contrast agents. So it can and will
happen.
The CT techs must be very knowledgeable of their responsibilities
for this IV site and be very skillful at inserting, monitoring,
assessing patency, and documenting. This is all outlined in the
practice standards established by the American Society of Radiologic
Technologists - www.asrt.org.
I would say these catheters absolutely must be placed by skilled
people, must be placed on an arm board and must be assessed for
patency by a positive blood return before, during and after the
procedure. Then this catheter must be removed immediately and not
allowed to be used for other infusions. The CT tech must document all
their interventions and they must be taught how to assess for and
correctly intervene with an infiltration.
When you can not even discuss these issues with the rad dept,
that is a serious problem. Don't forget that in a legal case, the
nursing involvement prior to the incident is also considered, so the
liability is not only with radiology. Did nursing insert the catheter
and then the patient was transferred to radiology while allowing for
lots of arm movement in the process? Did the CT tech assess for and
obtain a brisk blood return and flush to eliminate any concern about
infiltration prior to the contrast injection? How long had the
catheter been in place? All this will be considered. So I would keep
trying to open the lines of communication with the rad dept, not to
change their practice, but to set up safe parameters for patient care.
If that fails, then I guess one of my favorite sayings would have to
prevail - You can't fix stupid!. Lynn
At 9:00 PM -0400 5/6/06, [EMAIL PROTECTED] wrote:
Marcella
In our hospital we are getting the same requests. We have no choice but to place a line when possible. As we all know there are some pts for whom we can not do this. So far we have not been able to open a constructive dialogue with radiolog about this issue.
Carol Gosselin
Providence Ri
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Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
