Can Use This IV? I brought it from home...

[Depakote]

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CA-0 here, I was tangentially involved in a case earlier. It raised a question that I wanted to poll the audience about:

I'm down in the cath lab for my current rotation.

There's a lady s/p radical mastectomy, going for hyst tomorrow. Got a cath today, went fine, planning d/c home to return in AM. Nurse want's to leave the IV in (18) for the OR b/c "she only has the one good arm".

Would you send a patient home with an IV? More importantly, would you trust an IV that's been saline locked x 18-24 hours to deliver your induction agents?


They got the green light to do it from an attending, but I just see the lady getting restuck in pre-op. Am I missing something?

 

[dhb]

"she only has the one good arm".

That's bulls!!t

Would you send a patient home with an IV? More importantly, would you trust an IV that's been saline locked x 18-24 hours to deliver your induction agents?

Yes
Testing is key

 

[Freak]

Can you wire-exchange such things ?

Also, how much of a contraindication is using the other arm (assuming it is the side of the mastectomy and they are afraid of lymphedema).

 

[RussianJoo]

she's got two legs/feet and a neck too... having a patient go home with an IV for my patient population means either they'll use it to shoot up and/or they'll come back with line sepsis, even if it's just 24 hours. But no matter who the pt is I would never send them home with an IV, there's plenty of veins for me to access, and the simple fact that I can't use one arm for IVs is a very bad reason and an un-defendable reason in court as to why you sent a pt home with an IV.

 

[proman]

I don't think it's crazy at all if the patient is reliable and doesn't have a drug history (yes those exist). As long as the IV isn't a 14ga. Just put a Tegaderm over the whole thing and a loose wrap.

 

[Oggg]

Patient selection is key

 

[PMPMD]

she's got two legs/feet and a neck too...

👍👍

 

[PMPMD]

Would NOT d/c home with PIV in this litigious climate.

 

[TrustMe]

Agree with PMPMD. I would not use an IV on a pt. that came in from home for a procedure and I would not allow a pt. to be discharged home with an IV in place. If she showed up with an IV in place I would proceed to remove and place another one regardless of what "someone else" told her was okay.

On a better note, I am jealous that your cath lab is able to put in an 18ga IV. Ours usually puts in 22ga in the AC, regardless of what kind of veins the pt. has.

 

[proman]

So for the people who would remove it, let's say a patient comes in with a PICC. Do you refuse to use it and remove it? Should dialysis centers refuse to use a tunneled catheter if the patient has been home?

 

[deleted126335]

If it flows to gravity and flushes easily, why not use it?

 

[michigangirl]

nope- IV needs to come out or she gets admitted (which in this case there's no indication). The difference between tunneled lines, PICC lines, etc-- they were put in for the express purpose of home use or frequent use. Yes, there's a risk sending folks home with a "permanent" line too, just as easy to shoot undesirable things into it, but there is an actual medical indication for that line-- and that reason is well documented somewhere. Also, long-term lines are usually central and more stable. Who's to say her IV isn't going to come out in the middle of the night when she's sleeping at home and she bleeds like stink? unlikely, but still a a risk.

We get asked to do this in kids all the time, especially the bigger ones where an IV induction might be preferred for their general anesthetic. i.e. they come in for a sedated MRI one day, and scheduled for surgery the next day. Can bobby keep his IV so that he doesn't have to get stuck again? No. it's not medically indicated. Comes up ALL the time. I have never sent a kid home with a PIV.

I don't have any issues with "trusting" a line that was saline/hep locked for 24 hours. We do this all the time for patients with PICCs/hickmans etc who come from home. no difference. If it flushes without resistance, great.

 

[periopdoc]

Geez, glad that I live and work in a place where there is a good balance of humanism and medicine. Sounds like a great idea for a patient who is needle phobic or has access issues.

I see no reason to trust it less than an IV that had been in on the floor for a couple of days or placed in the field, but I would almost certainly place a second line for the case once she was asleep just like I would with either of those other lines.

- pod

 

[pgg]

Patient selection is key

I'd be willing to send about 90% of my .mil patients home with an IV, if they were due back for surgery the next day.

I'd be willing to to the same for about 50% of my .civ moonlighting patients.

 

[michigangirl]

Geez, glad that I live and work in a place where there is a good balance of humanism and medicine. Sounds like a great idea for a patient who is needle phobic or has access issues.

I see no reason to trust it less than an IV that had been in on the floor for a couple of days or placed in the field, but I would almost certainly place a second line for the case once she was asleep just like I would with either of those other lines.

- pod

Not an issue of humanism. It's an issue of safety. and if I took care of adults most of the time, I'd be hard pressed to "judge" who I felt comfortable sending home with an IV and who I wouldn't. Sounds like a lot of judging a book by it's cover.

periop doc-- it sounds like this is something you would do and have done without issue. Care to give us examples?

An example of the "unknown" IV for comment. Severely autistic patient in need of multiple surgeries whose mother places IVs for a living. She knows that mask induction or IV placement for induction will be a very traumatizing experience for him if done by people he's not familiar with (and physically dangerous for the staff). So she places an IV in him at home without any issue (20 gauge) and brings him to the hospital with the IV. If the IV flushes easily-- would anyone have an issue using it for a little midazolam and then induction? I wouldn't. Put in as many IVs as you want once off to sleep.The most humanistic option for the patient.

Key is-- I didn't place the IV, send him home, and have to worry about what is going to happen to that IV once out of my vision. It's not the standard of care, and if he gets a cellulitis, it becomes painful in the middle of the night, he bleeds-- am I not accountable? Do people sign a consent form before they go home with the IV? Because they definitely sign a consent form which documents the risks when they get a central line, PICC line. Not sure how this is any different.

 

[periopdoc]

periop doc-- it sounds like this is something you would do and have done without issue. Care to give us examples?

Never done it, never been asked, but I would not think twice if I was. As far as an example, the patient in the OP is the example I already used. I would expect some degree of need (needle phobic or history of difficult access) and I would require that they had a scheduled need within a reasonable time frame.

Not an issue of humanism. It's an issue of safety...

Key is-- I didn't place the IV, send him home, and have to worry about what is going to happen to that IV once out of my vision. It's not the standard of care, and if he gets a cellulitis, it becomes painful in the middle of the night, he bleeds-- am I not accountable? Do people sign a consent form before they go home with the IV? Because they definitely sign a consent form which documents the risks when they get a central line, PICC line. Not sure how this is any different.

Sure it's an issue of humanism and a measure of where you operate on the humanism/ liability ratio. Not to say you don't have empathy, or even that I have more empathy, just that you have a greater fear of liability in the environment in which you work than I do in my environment. That is part of why I work where I work. It also helps that I don't have JCAHO looking over my shoulders.

If YOU need a consent, get a consent, but I would ask consent for what (ignoring the fact that written consent in anesthesia is somewhat of a joke anyway)? The JCAHOfication of medicine is really getting out of hand. You have already performed the procedure so placement of the IV was "covered" by the initial consent. Do you also write a separate consent when you send a patient home with a PICC? All you need is a good set of boilerplate discharge instructions. Come to the ER for pain, swelling, fever, chills, nausea, bleeding....


- pod

 

[dhb]

Got a cath today, went fine, planning d/c home to return in AM.

I didn't place the IV, send him home, and have to worry about what is going to happen to that IV once out of my vision.

Well in this case the anesthesiologist didn't place the iv either...
If it works great, if not no biggie...